Information Collection

Report of Verified Case of Tuberculosis (RVCT)

IC 6627 under ICR 201610-0920-012 · OMB 0920-0026.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Report of Verified Case of Tuberculosis (RVCT)	Form
Report of Verified Case of Tuberculosis Att 3_RVCT Form.pdf	Form
Attachment 4.pdf Instructions to Respondents	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	NA	Report of Verified Case of Tuberculosis	Att 3_RVCT Form.pdf	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 60

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	9,420	-540	9,960
Annual IC Time Burden (Hours)	5,495	-315	5,810
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Instructions to Respondents	Attachment 4.pdf	02/05/2014

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