Clinician Public Health Department Follow-Up Script - TB Treating Physicians

Information Collection for Tuberculosis Data from Referring Entities to Cure TB

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1186 can be found here:

Documents and Forms

Document Name Document Type
Form 16AWE Clinician Public Health Department Follow-Up Script - TB Treating Physicians Form and Instruction
16AWE Attachment F CureTB Clinician_PHD Follow-up script Attachment F CureTB Clinician_PHD Follow-up script.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Clinician Public Health Department Follow-Up Script - TB Treating Physicians	Agency IC Tracking Number:	16AWE

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	16AWE	Attachment F CureTB Clinician_PHD Follow-up script	Attachment F CureTB Clinician_PHD Follow-up script.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 62812

Number of Respondents: 500	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,500	1,500
Annual IC Time Burden (Hours)	250	250
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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