Att J_Influenza Associated Pediatric Mortality Case Report Form

National Disease Surveillance Program - II. Disease Summaries

OMB: 0920-0004

IC ID: 199050

Information Collection (IC) Details

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Att J_Influenza Associated Pediatric Mortality Case Report Form
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form NA Influenza-Associated Pediatric Mortality Case Report Attachment J_Influenza Associated Pediatric Mortality Case Report Form.pdf NA Yes Yes Fillable Printable

Health Public Health Monitoring

 

57 0
   
State, Local, and Tribal Governments
 
   65 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 114 0 0 0 0 114
Annual IC Time Burden (Hours) 57 0 0 0 0 57
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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