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

Information Collection for Tuberculosis Data from Referring Entities to CureTB

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

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:

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

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 %

	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

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.