Document
COVID-19 Patient Impact Module Form - State and Local Health Departments
ICR 202005-0920-008 · OMB 0920-1290 · Object 101196701.
This document may belong to an older filing. More recent activity for OMB 0920-1290:
Document Viewer [docx]
Status: The document is viewable, but some background extraction is still pending.
Queue: Repair is in progress, but the document is still incomplete and remains in the worker queue. (priority 70 · next 2026-07-17 11:38:50)
Missing: html
Download: Source copy (docx)
Loading document viewer…
Document Metadata
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
|---|---|
| File Title | COVID-19 Patient Impact Module Form - State and Local Health Departments |
| Author | Wu, Hsiu (CDC/DDID/NCEZID/DHQP) |
| File Created | 2021-01-14 |
| Conversion State | partial |