Information Collection

Multistate outbreak of coccidioidomycosis (Valley fever) in U.S. students and adults who traveled to Tijuana area, Mexico

IC 232840 under ICR 201807-0920-001 · OMB 0920-1011.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1011 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1011 Multistate outbreak of coccidioidomycosis (Valley fever) in U.S. students and adults who traveled to Tijuana area, Mexico	Form and Instruction
0920-1011 Questionnaire - Valley Fever Appendix1_Questionnaire REVISED.doc	Form and Instruction
Investigation request - Valley fever - PRA application.pdf Letter of Invitation	IC Document
0920-1011 GenIC Request 2018002-XXX Valley Fever_Multi.msg Burden Request Memo - Email	IC Document
2018002-XXX Valley Fever_Multi.docx 0920-1011 GenIC Request	IC Document

IC Title:

Multistate outbreak of coccidioidomycosis (Valley fever) in U.S. students and adults who traveled to Tijuana area, Mexico

Agency IC Tracking Number:

0920-1011-18

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-1011	Questionnaire - Valley Fever	Appendix1_Questionnaire REVISED.doc	NA	No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title: 09-20-0113 - Epidemic Investigation Case Records

FR Citation: 51 FR 42466

Number of Respondents: 130

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	130	130
Annual IC Time Burden (Hours)	43	43
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Letter of Invitation	Investigation request - Valley fever - PRA application.pdf	08/28/2018
Burden Request Memo - Email	0920-1011 GenIC Request 2018002-XXX Valley Fever_Multi.msg	08/28/2018
0920-1011 GenIC Request	2018002-XXX Valley Fever_Multi.docx	08/28/2018

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