DOG EXPOSURE QUESTIONNAIRE - State and Local Health Department Staff

Enhanced surveillance for cases linked to a multistate outbreak of multidrug-resistant Campylobacter infections linked to contact with pet store puppies

OMB: 0920-1261

IC ID: 235774

Information Collection (IC) Details

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DOG EXPOSURE QUESTIONNAIRE - State and Local Health Department Staff
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-XXXX Dog Exposure Questionnaire 3. Dog exposure questionnaire.docx NA Yes Yes Fillable Fileable

Disaster Management Emergency Response

 

50 0
   
State, Local, and Tribal Governments
 
   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 50 0 50 0 0 0
Annual IC Time Burden (Hours) 25 0 25 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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