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

Emergency Epidemic Investigation Data Collections - Expedited Reviews (Y3Q4)

OMB: 0920-1011

IC ID: 234261

Information Collection (IC) Details

View Information Collection (IC)

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

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-1011 Patient Screening Questionnaire Appendix1_Questionnaire.doc NA No   Paper Only

Health Illness Prevention

09-20-0113 - Epidemic Investigation Case Records  51 FR 42466

45 0
   
Individuals or Households
 
   0 %

  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 45 0 45 0 0 0
Annual IC Time Burden (Hours) 15 0 15 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Investigation Request Memo Investigation request - Valley fever - PRA application.pdf 11/30/2018
Burden Memo Email 0920-1011 GenIC Burden Memo Email.msg 11/30/2018
0920-1011 GenIC Request 2019002-XXX Valley Fever_Multi.docx 11/30/2018
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

© 2024 OMB.report | Privacy Policy