Att. CC Suspect Respiratory Virus Patient Form

National Disease Surveillance Program - II. Disease Summaries

OMB: 0920-0004

IC ID: 228082

Information Collection (IC) Details

View Information Collection (IC)

Att. CC Suspect Respiratory Virus Patient Form
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form NA Suspect Respiratory Virus Patient Form Attachment CC_Suspect Respiratory Virus Patient Form.doc NA Yes Yes Fillable Printable

Health Public Health Monitoring

 

10 0
   
State, Local, and Tribal Governments
 
   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 50 0 50 0 0 0
Annual IC Time Burden (Hours) 25 0 25 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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