Information Collection

Undetermined source, mode of transmission, and risk factors for Hepatitis A virus (HAV) transmission ‒ Hawaii, 2016

IC 222856 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⚠️ Notice: This information collection may be referencing outdated material.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, mode of transmission, and risk factors for Hepatitis A virus (HAV) transmission ‒ Hawaii, 2016	Form and Instruction
HEPATITIS A VIRUS (HAV) OUTBREAK HAWAII, 2016—CASE QUEST Appendix 1 HAV Case-Control Questionnaire Draft_CaseForm.docx	Form and Instruction
HEPATITIS A VIRUS (HAV) OUTBREAK HAWAII, 2016—CONTROL QU Appendix 2 HAV Case-Control Questionnaire Draft_ControlForm.docx	Form and Instruction
Letter of Invitation_August32016.pdf Letter of Invitation Hawaii	IC Document
GenIC Request Form - EEI ICR_HAV_HI.docx Emergency GenIC Request	IC Document
Burden Memo Email.msg Burden Memo - Email	IC Document

IC Title:

Undetermined source, mode of transmission, and risk factors for Hepatitis A virus (HAV) transmission â Hawaii, 2016

Agency IC Tracking Number:

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	HEPATITIS A VIRUS (HAV) OUTBREAK HAWAII, 2016âCASE QUESTIONNAIRE	Appendix 1 HAV Case-Control Questionnaire Draft_CaseForm.docx	NA	No		Paper Only
Form and Instruction	NA	HEPATITIS A VIRUS (HAV) OUTBREAK HAWAII, 2016âCONTROL QUESTIONNAIRE	Appendix 2 HAV Case-Control Questionnaire Draft_ControlForm.docx	NA	No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title: 09-20-0113 - Epidemic Investigation Case Records

FR Citation: 51 FR 42466

Number of Respondents: 600

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	600	600
Annual IC Time Burden (Hours)	225	225
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Letter of Invitation Hawaii	Letter of Invitation_August32016.pdf	08/05/2016
Emergency GenIC Request	GenIC Request Form - EEI ICR_HAV_HI.docx	08/05/2016
Burden Memo - Email	Burden Memo Email.msg	08/05/2016

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