Information Collection

Coordination with TB Treating Physician/Foreign Health Authority in New Country

IC 226739 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⚠️ Notice: This information collection may be referencing outdated material.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
Coordination with TB Treating Physician/Foreign Health Authority in New Country	Form and Instruction
Telephone Script for Clinician/Foreign Health Authority Att. E CureTB Clinician_PHD Follow-up script.docx	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Coordination with TB Treating Physician/Foreign Health Authority in New Country

Agency IC Tracking Number:

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	Telephone Script for Clinician/Foreign Health Authority Referral Follow-up	Att. E CureTB Clinician_PHD Follow-up script.docx		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: 870

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	2,610	1,110	1,500
Annual IC Time Burden (Hours)	435	185	250
Annual IC Cost Burden (Dollars)	10,279	10,279	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.