EDN TB Follow-up Worksheet

US Tuberculosis Follow-up Worksheet for Newly Admitted Persons with Overseas Tuberculosis Classifications

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1238 can be found here:

Documents and Forms

Document Name Document Type
EDN TB Follow-up Worksheet Form
EDN TB Follow-up Worksheet Attachment 3 TB Follow up Worksheet.pdf Form

Information Collection (IC) Details

IC Title:	EDN TB Follow-up Worksheet	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	EDN TB Follow-up Worksheet	Attachment 3 TB Follow up Worksheet.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Alien Tuberculosis Follow-up Program	FR Citation: 51 FR 42462

Number of Respondents: 550	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	26,400	26,400
Annual IC Time Burden (Hours)	13,200	13,200
Annual IC Cost Burden (Dollars)	493,416	493,416

Documents for IC

Title	Document	Date Uploaded
No associated records found

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