Survey 2 - Confirmed Shigellosis Cases (Group 3)

Investigation of a Cluster of Extensively Drug Resistant Shigellosis Associated with a Cruise Ship

Documents and Forms

Document Name Document Type
Survey 2 - Confirmed Shigellosis Cases (Group 3) Form and Instruction
Appendix C - Survey Instrument 2 Appendix C. SurveyInstrument2_3.12.2020a.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Survey 2 - Confirmed Shigellosis Cases (Group 3)	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 and Instruction	NA	Appendix C - Survey Instrument 2	Appendix C. SurveyInstrument2_3.12.2020a.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: 09-20-0136 - Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 62812

Number of Respondents: 100	Number of Respondents for Small Entity: 0

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	100	100
Annual IC Time Burden (Hours)	17	17
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.