(drss) Concession/partner Employee Illness Report

National Park Service (NPS) Office of Public Health (OPH) Disease Reporting and Surveillance Forms

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1024-0286 can be found here:

Documents and Forms

Document Name Document Type
Form NPS Form 10-685 (DRSS) CONCESSION/PARTNER EMPLOYEE ILLNESS REPORT Form
NPS Form 10-685 DISEASE REPORTING AND SURVEILLANCE SYSTEM (DRSS) CONCESS NPS DRSS EMPLOYEE ILLNESS REPORT_final.docx Form

Information Collection (IC) Details

IC Title:	(DRSS) CONCESSION/PARTNER EMPLOYEE ILLNESS REPORT	Agency IC Tracking Number:

Is this a Common Form? No		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	NPS Form 10-685	DISEASE REPORTING AND SURVEILLANCE SYSTEM (DRSS) CONCESSION/PARTNER EMPLOYEE ILLNESS REPORT	NPS DRSS EMPLOYEE ILLNESS REPORT_final.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 300	Number of Respondents for Small Entity: 300

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	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.