Homeless Shelter Staff - Homeless Shelter Modified Screener

SARS-CoV-2 Epidemiologic Data Collections

Documents and Forms

Document Name Document Type
Homeless Shelter Staff - Homeless Shelter Modified Screener Form and Instruction
Homeless Shelter Modified Screener 9. homeless_homeless shelter modified screener_instrument_OMB (omb)_ko.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Homeless Shelter Staff - Homeless Shelter Modified Screener	Agency IC Tracking Number:

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
Form and Instruction	NA	Homeless Shelter Modified Screener	9. homeless_homeless shelter modified screener_instrument_OMB (omb)_ko.docx	NA	No		Paper Only

Line of Business: Disaster Management

Subfunction: Emergency Response

Privacy Act System of Records
Title: Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 92812

Number of Respondents: 2,400	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: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	4,800	4,800
Annual IC Time Burden (Hours)	1,200	1,200
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.