Information Collection

DTBE/FSB Rifampin (RIF) Email Assessment

IC 244515 under ICR 202005-0920-010 · OMB 0920-1027.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1027 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att 1 RIF Followup Survey.docx	Other-WORD
Customer Service GenIC Clearance Template_Rif Assessment.docx Request for Approval	IC Document

IC Title:

DTBE/FSB Rifampin (RIF) Email Assessment

Agency IC Tracking Number:

0920-1027-21AX

IC Status: New

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
Other-WORD			Att 1 RIF Followup Survey.docx		No		Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 61

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	122	122
Annual IC Time Burden (Hours)	122	122
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Request for Approval	Customer Service GenIC Clearance Template_Rif Assessment.docx	11/15/2020

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.