Att X Middle East Respiratory Syndrome Coronavirus (MERS) Patient Under Investigation (PUI) Form

National Disease Surveillance Program - II. Disease Summaries

OMB: 0920-0004

IC ID: 212473

Information Collection (IC) Details

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Att X Middle East Respiratory Syndrome Coronavirus (MERS) Patient Under Investigation (PUI) Form
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form None Middle East Respiratory Syndrome (MERS) Patient Under Investigation (PUI) Short Form Attachment X_Middle East Respiratory Syndrome (MERS) Patient Under Investigation (PUI) Short Form.pdf NA Yes Yes Fillable Printable

Health Public Health Monitoring

 

57 0
   
Individuals or Households
 
   100 %

  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 171 0 0 0 0 171
Annual IC Time Burden (Hours) 71 0 0 0 0 71
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
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