Information Collection Request

Factors Influencing the Transmission of Influenza

ICR 201708-0920-017 · OMB 0920-0888 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 0920-0888 Medical Testing Form and Instruction Modified Available
Form 0920-0888 Health Questionnaire Form Modified Available
Informed Consent Form Modified Available
Influenza Study - PIA.PDF Supplementary Document Uploaded 2017-12-15 Available
30dy FRN (published).pdf Supplementary Document Uploaded 2017-12-15 Available
Attachment 7 - IRB approval for study.pdf Supplementary Document Uploaded 2017-12-15 Available
Attachment 2 - 60-day Federal Register Notice.pdf Supplementary Document Uploaded 2017-12-15 Available
Attachment 1 - Legislation Authorizing Data Collection.docx Supplementary Document Uploaded 2017-12-15 Available
Influenza Section B 2017-06-21.docx Supporting Statement B Uploaded 2017-12-15 Available
Influenza Section A 2017-12-15 Lindsley changes.docx Supporting Statement A Uploaded 2017-12-15 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
228011 Initial Verbal Screening Other-WORD New
196083 Medical Testing Form and Instruction Modified
196082 Health Questionnaire Form Modified
196081 Informed Consent Form Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
02/28/2021 36 Months From Approved
450 0 0
148 0 0
0 0 0





Reginfo record details
4
table that charts list of burden
IC Title Form No. Form Name
Initial Verbal Screening
Informed Consent none Consent
Health Questionnaire 0920-0888 Health Questionnaire
Medical Testing 0920-0888 Medical Testing

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 450 0 0 450 0 0
Annual Time Burden (Hours) 148 0 0 148 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No