Information Collection

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

IC 226739 under ICR 201705-0920-004 · OMB 0920-1186.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

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	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 %

table that charts list of burden
	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

table that charts IC Documents
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.