Undetermined risk factors for long term sequela resulting from Rocky Mountain spotted fever-Arizona, 2018

Emergency Epidemic Investigation Data Collections - Expedited Reviews (Y3Q4)

OMB: 0920-1011

IC ID: 234030

Information Collection (IC) Details

View Information Collection (IC)

Undetermined risk factors for long term sequela resulting from Rocky Mountain spotted fever-Arizona, 2018 0920-1011-19EE
 
Unchanged
 
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 Appendix 2. Patient Screening Questionnaire_7-19-2018.pdf NA No   Paper Only
Form and Instruction 0920-1011 Neurologic Exam Form Appendix 3. Neuro Exam Form.pdf NA No   Paper Only

Disaster Management Emergency Response

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

1 0
   
Individuals or Households
 
   0 %

  Requested 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 1 0 0 0 0 1
Annual IC Time Burden (Hours) 1 0 0 0 0 1
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Letter of Invitation Letter of Invitation.pdf 11/14/2018
IRB Approval IRB Approval.pdf 11/14/2018
0920-1011 EEI GenIC Request 2019001-XXX RMSF_AZ.docx 11/14/2018
Burden Memo Email Burden Memo Email RMSF_AZ v2.msg 11/14/2018
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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