Information Collection

Daily Sympton Check

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

Documents and Forms

Document Name Document Type
Daily Symptom Check.docx Other-Recorded

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.