Covid-19 Contact Tracing Reporting Form

COVID-19 Tracing Reporting Form

OMB: 1670-0044

IC ID: 244227

Information Collection (IC) Details

View Information Collection (IC)

COVID-19 CONTACT TRACING REPORTING FORM
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction DHS Form XXX (10/20) COVID-19 CONTACT TRACING REPORTING FORM DHS Form XXX_1670-NEW_COVID-19 Contact Tracing Reporting Form_3_FORM-v1.pdf Yes Yes Fillable Fileable Signable

Health Public Health Monitoring

PIA-069 DHS Surveys, Interviews, and Focus Groups   73 FR 71659

166 0
   
State, Local, and Tribal Governments
 
   100 %

  Approved 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 166 0 166 0 0 0
Annual IC Time Burden (Hours) 111 0 111 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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