Information Collection

Undetermined source of Elizabethkingia anophelis infections among Wisconsin residents - Wisconsin, 2016

IC 222478 under ICR 201608-0920-012 · OMB 0920-1011.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1011 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Undetermined source of Elizabethkingia anophelis infections among Wisconsin residents - Wisconsin, 2016	Form and Instruction
Focus Group Discussion Guide Appendix 1. Focus Group.doc	Form and Instruction
LOI_EKM_WI Focus Groups_mw JD rev 7 11 JPD final signed.pdf Letter of Invitation - Wisconsin	IC Document
2016019-XXX Elizabethkingia_WI.docx GenIC Request GenIC - Elizabethkingia anophelis - Wisconsin	IC Document
Burden Memo Email 0920-1011.msg Burden Request Memo - Email	IC Document

IC Title:

Undetermined source of Elizabethkingia anophelis infections among Wisconsin residents - Wisconsin, 2016

Agency IC Tracking Number:

0920-1011-16AVO

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NA	Focus Group Discussion Guide	Appendix 1. Focus Group.doc	NA	No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title: 09-20-0113 - Epidemiologic Studies and Surveillance of Disease Problems

FR Citation: 51 FR 42466

Number of Respondents: 25

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	25	25
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Letter of Invitation - Wisconsin	LOI_EKM_WI Focus Groups_mw JD rev 7 11 JPD final signed.pdf	07/14/2016
GenIC Request GenIC - Elizabethkingia anophelis - Wisconsin	2016019-XXX Elizabethkingia_WI.docx	07/14/2016
Burden Request Memo - Email	Burden Memo Email 0920-1011.msg	07/14/2016

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.