Information Collection

Cure TB Contact Source Investigation (CI/SI) Notification - LHD

IC 226738 under ICR 202004-0920-019 · OMB 0920-1186.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1186 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Cure TB Contact Source Investigation (CI/SI) Notification - LHD	Form and Instruction
CureTB Contact/Source Investigation (CI/SI) Notification Att. D -CureTB Contact Source Investigation.pdf	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Cure TB Contact Source Investigation (CI/SI) Notification - LHD

Agency IC Tracking Number:

16AWE

Is this a Common Form? No

IC Status: Modified

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	n/a	CureTB Contact/Source Investigation (CI/SI) Notification	Att. D -CureTB Contact Source Investigation.pdf		No		Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 09-20-0171, Quarantine- and Traveler-related Activities Including Records for Contact Tracing Investigation and Notification under 42 CFR Parts 70 and 71

FR Citation: 72 FR 70867

Number of Respondents: 20

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	100	0	100
Annual IC Time Burden (Hours)	50	0	50
Annual IC Cost Burden (Dollars)	2,230	2,230	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.