Att. 7_ChronicQFever Enhanced Surveillance

Chronic Q Fever in the United States: Enhanced Clinical Surveillance

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1305 can be found here:

Documents and Forms

Document Name Document Type
Form 0920- Att. 7_ChronicQFever Enhanced Surveillance Form and Instruction
0920- Chronic Q Fever Enhanced Surveillance Att. 7 ChronicQFever information collection instrument.pdf Form and Instruction
Att. 6 REDCap Chronic Q enhanced survey screenshots.docx Att. 6_REDCap Chronic Q enhanced survey (screenshots) IC Document
Att 5. Introduction email with survery link.docx Att 5._Introduction email with survey IC Document

Information Collection (IC) Details

IC Title:	Att. 7_ChronicQFever Enhanced Surveillance	Agency IC Tracking Number:	0920-20DV

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	0920-	Chronic Q Fever Enhanced Surveillance	Att. 7 ChronicQFever information collection instrument.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 15	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	15	15
Annual IC Time Burden (Hours)	5	5
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att. 6_REDCap Chronic Q enhanced survey (screenshots)	Att. 6 REDCap Chronic Q enhanced survey screenshots.docx	05/28/2020
Att 5._Introduction email with survey	Att 5. Introduction email with survery link.docx	05/28/2020

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