Information Collection

Filovirus Diagnostic Specimen Submission

IC 206055 under ICR 202007-0920-010 · OMB 0920-0263.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Filovirus Diagnostic Specimen Submission	Form and Instruction
Ebola Diagnostic Specimen Submission Form for quarantine Attachment 8-Filovirus Diagnostic Speciment form.pdf	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Filovirus Diagnostic Specimen Submission

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 71.53(v)

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
Form and Instruction	n/a	Ebola Diagnostic Specimen Submission Form for quarantined non-human primates	Attachment 8-Filovirus Diagnostic Speciment form.pdf		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 09-20-0171 Quarantine and Traveler Related Activities, Including Records for Contact Tracing, Investigation, and Notification Under 42 CFR Part 70-71

FR Citation: 72 FR 70867

Number of Respondents: 10

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	100	0	100
Annual IC Time Burden (Hours)	33	0	33
Annual IC Cost Burden (Dollars)	1,600	100	1,500

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.