Information Collection

Homeless Shelter Staff - Homeless Symptom Follow-Up

IC 241643 under ICR 202004-0920-016 · OMB 0920-1297.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1297 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Homeless Shelter Staff - Homeless Symptom Follow-Up	Form and Instruction
Homeless Symptom Follow-Up 10. Homeless_ symptom follow-up_instrument_OMB (omB)_ko.docx	Form and Instruction

IC Title:

Homeless Shelter Staff - Homeless Symptom Follow-Up

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 and Instruction	NA	Homeless Symptom Follow-Up	10. Homeless_ symptom follow-up_instrument_OMB (omB)_ko.docx	NA	No		Paper Only

Line of Business: Disaster Management

Subfunction: Emergency Response

Privacy Act System of Records

Title: Epidemiologic Studies and Surveillance of Disease Problems

FR Citation: 57 FR 92812

Number of Respondents: 50

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	700	700
Annual IC Time Burden (Hours)	58	58
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.