Gonorrhea Patient Interview

Enhanced STD Surveillance Network

OMB: 0920-1072

IC ID: 214281

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Gonorrhea Patient Interview
 
No Removed
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction none Patient Interview Script Att 3D Patient Interview_DataElements.pdf Yes Yes Fillable Fileable

Health Public Health Monitoring

 

3,225 0
   
Individuals or Households
 
   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 0 0 0 -3,225 0 3,225
Annual IC Time Burden (Hours) 0 0 0 -538 0 538
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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