Gonorrhea Patient Interview (Section 1)

Enhanced STD Surveillance Network

OMB: 0920-1072

IC ID: 232371

Information Collection (IC) Details

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Gonorrhea Patient Interview (Section 1) 0920-1072
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-1072 Gonorrhea Patient Interview section 1 Att 8_InterviewTemplate_GC_syphilis.pdf NA No   Fillable Fileable

Health Public Health Monitoring

 

7,380 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 7,380 0 1,888 0 0 5,492
Annual IC Time Burden (Hours) 1,230 0 315 0 0 915
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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