Case Report Form for Histoplasmosis Enhanced Surveillance - Health Department Personnel

Enhanced Surveillance for Histoplasmosis

OMB: 0920-1230

IC ID: 230643

Information Collection (IC) Details

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Case Report Form for Histoplasmosis Enhanced Surveillance - Health Department Personnel
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction NA Case Report Form for Histoplasmosis Enhanced Surveillance Att 3 - CRF for Histoplasmosenhanced surveillance.docx NA Yes Yes Fillable Fileable

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 300 0 300 0 0 0
Annual IC Time Burden (Hours) 75 0 75 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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