Information Collection

Daily Sympton Check

IC 239872 under ICR 202005-0920-013 · OMB 0920-1287.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Daily Symptom Check.docx	Other-Recorded

IC Title:

Daily Sympton Check

Agency IC Tracking Number:

0920-20HF

Is this a Common Form? No

IC Status: Unchanged

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-Recorded			Daily Symptom Check.docx		No		Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	280,000	280,000
Annual IC Time Burden (Hours)	23,333	23,333
Annual IC Cost Burden (Dollars)	0	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.