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Investigation of SARS-CoV-2 transmission in a jail - Louisiana, 2020
Emergency Epidemic Investigation Data Collections - Burden Hour Increase 01SEP2020
OMB: 0920-1011
IC ID: 241734
OMB.report
HHS/CDC
OMB 0920-1011
ICR 202009-0920-002
IC 241734
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1011 can be found here:
2022-10-07 - Revision of a currently approved collection
2022-01-13 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Form 0920-1011
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)
IC Title:
Investigation of SARS-CoV-2 transmission in a jail - Louisiana, 2020
Agency IC Tracking Number:
0920-1011-20OF
IC Status:
Removed
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
Form and Instruction
0920-1011
Facility Assessment
Appendix 1. Facility Survey.docx
NA
No
Paper Only
Form and Instruction
0920-1011
Survey - Day 0
Appendix 2. Survey Day 0.docx
NA
No
Paper Only
Form and Instruction
0920-1011
Survey - Day 3-4
Appendix 3. Survey Day 3.docx
NA
No
Paper Only
Form and Instruction
0920-1011
Survey - Day 14
Appendix 4. Survey Day 14.docx
NA
No
Paper Only
Form and Instruction
0920-1011
Respiratory Testing Form
Appendix 5. Lab requisition form cover page.docx
NA
No
Paper Only
Form and Instruction
0920-1011
COVID-19 Test Request Form
Appendix 5. COVID-19 Test Request Form.pdf
NA
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Disaster Management
Subfunction:
Emergency Response
Privacy Act System of Records
Title:
Epidemic Investigation Case Records - SORN number 09-20-0113
FR Citation:
51 FR 42466
Number of Respondents:
910
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
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
Title
Document
Date Uploaded
0920-1011 GenIC Request
2020004-XXX COVID-19 Jail_LA.docx
05/07/2020
Letter of Invitation
Letter of Invitation.pdf
05/07/2020
Burden Request Memo
URGENT 0920-1011 GenIC Request 2020004-XXX COVID-19 Jail_LA.msg
05/08/2020
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.