Information Collection

(drss) Concession/partner Employee Illness Report

IC 236925 under ICR 201907-1024-002 · OMB 1024-0286.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form NPS Form 10-685 DISEASE REPORTING AND SURVEILLANCE SYSTEM (DRSS) CONCESSION/PARTNER EMPLOYEE ILLNESS REPORT (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

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	NPS Form 10-685				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 %

table that charts list of burden
	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

table that charts IC Documents
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.

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