Information Collection

Investigation of SARS-CoV-2 transmission in a jail - Louisiana, 2020

IC 241734 under ICR 202009-0920-002 · OMB 0920-1011.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Form 0920-1011
Facility Assessment Investigation of SARS-CoV-2 transmission in a jail - Louisiana, 2020
Form and Instruction
Form 0920-1011
Survey - Day 0 Investigation of SARS-CoV-2 transmission in a jail - Louisiana, 2020
Form and Instruction
Form 0920-1011
Survey - Day 3-4 Investigation of SARS-CoV-2 transmission in a jail - Louisiana, 2020
Form and Instruction
Form 0920-1011
Survey - Day 14 Investigation of SARS-CoV-2 transmission in a jail - Louisiana, 2020
Form and Instruction
Form 0920-1011
Respiratory Testing Form Investigation of SARS-CoV-2 transmission in a jail - Louisiana, 2020
Form and Instruction
Form 0920-1011
COVID-19 Test Request Form Investigation of SARS-CoV-2 transmission in a jail - Louisiana, 2020
Form and Instruction
0920-1011 Facility Assessment
Appendix 1. Facility Survey.docx
Form and Instruction
0920-1011 Survey - Day 0
Appendix 2. Survey Day 0.docx
Form and Instruction
0920-1011 Survey - Day 3-4
Appendix 3. Survey Day 3.docx
Form and Instruction
0920-1011 Survey - Day 14
Appendix 4. Survey Day 14.docx
Form and Instruction
0920-1011 Respiratory Testing Form
Appendix 5. Lab requisition form cover page.docx
Form and Instruction
0920-1011 COVID-19 Test Request Form
Appendix 5. COVID-19 Test Request Form.pdf
Form and Instruction
2020004-XXX COVID-19 Jail_LA.docx
0920-1011 GenIC Request
IC Document
Letter of Invitation.pdf
Letter of Invitation
IC Document
URGENT 0920-1011 GenIC Request 2020004-XXX COVID-19 Jail_LA.msg
Burden Request Memo
IC Document

Information Collection (IC) Details

View Information Collection (IC)

layout table

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 0920-1011 NA No   Paper Only
Form and Instruction 0920-1011 NA No   Paper Only
Form and Instruction 0920-1011 NA No   Paper Only
Form and Instruction 0920-1011 NA No   Paper Only
Form and Instruction 0920-1011 NA No   Paper Only
Form and Instruction 0920-1011 NA No   Paper Only

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 0 0 -910 0 0 910
Annual IC Time Burden (Hours) 0 0 -356 0 0 356
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
0920-1011 GenIC Request 05/07/2020
Letter of Invitation 05/07/2020
Burden Request Memo 05/08/2020
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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