TB Indicator Reporting Form

Information Collection for Tuberculosis Data from Panel Physicians

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1102 can be found here:

Documents and Forms

Document Name Document Type
TB Indicator Reporting Form Form
TB Indicator Data Reporting Form Attachment C TB Indicator Reporting Form_2018_FinalForOMB.xls Form

Information Collection (IC) Details

IC Title:	TB Indicator Reporting Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	TB Indicator Data Reporting Form	Attachment C TB Indicator Reporting Form_2018_FinalForOMB.xls		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 336	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	336	-17	353
Annual IC Time Burden (Hours)	1,008	-1,640	2,648
Annual IC Cost Burden (Dollars)	104,459	104,459	0

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.