Undetermined cause of Acute Flaccid Myelitis, multiple states, United States, 2018

Emergency Epidemic Investigation Data Collections - Expedited Reviews (Y3Q4)

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form 0920-1011 Undetermined cause of Acute Flaccid Myelitis, multiple states, United States, 2018 Form and Instruction
0920-1011 Acute Flaccid Myelitis Case Questionnaire - English Appendix 1. Questionnaire - English.docx Form and Instruction
0920-1011 Acute Flaccid Myelitis Case Questionnaire - Spanish Appendix 2. Questionnaire - Spanish.docx Form and Instruction
LOI-MN.AFM.pdf Letter of Invitation - MN IC Document
Concurrence emails compilation.pdf Letter of Invitation - Concurrence_Multiple States IC Document
0920-1011 Burden Table - Email.msg Burden Table - Email IC Document
2019003-XXX AFM_multi_REVISED 13JUN2019.docx EEI GenIC Request IC Document

Information Collection (IC) Details

IC Title:	Undetermined cause of Acute Flaccid Myelitis, multiple states, United States, 2018	Agency IC Tracking Number:	0920-1011-19BHA

IC Status: New

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 and Instruction	0920-1011	Acute Flaccid Myelitis Case Questionnaire - English	Appendix 1. Questionnaire - English.docx	NA	No		Fillable Printable
Form and Instruction	0920-1011	Acute Flaccid Myelitis Case Questionnaire - Spanish	Appendix 2. Questionnaire - Spanish.docx	NA	No		Fillable Printable

Line of Business: Disaster Management

Subfunction: Emergency Response

Privacy Act System of Records
Title: Epidemic Investigation Case Records - 09-20-0113	FR Citation: 51 FR 42466

Number of Respondents: 210	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	210	210
Annual IC Time Burden (Hours)	210	210
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Letter of Invitation - MN	LOI-MN.AFM.pdf	06/12/2019
Letter of Invitation - Concurrence_Multiple States	Concurrence emails compilation.pdf	06/12/2019
Burden Table - Email	0920-1011 Burden Table - Email.msg	06/12/2019
EEI GenIC Request	2019003-XXX AFM_multi_REVISED 13JUN2019.docx	06/13/2019

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