Information Collection

Covid-19 Contact Tracing

IC 242419 under ICR 202102-1601-003 · OMB 1601-0027.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
COVID-19 Contact Tracing Form.docx	Other-Mock Up
COVID-19 Contact Tracing Form.docx	Other-Mock Up
COVID-19 Contact Tracing Script- Interview of COVID POSITIVE DHS Personnel.docx	Other-Interview Script
COVID-19 Contact Tracing Script- Interview of COVID POSITIVE DHS Personnel.docx	Other-Interview Script
COVID-19 Contact Tracing Notification Script- DHS Personnel.docx	Other-Notifiation Script
COVID-19 Contact Tracing Notification Script- DHS Personnel.docx	Other-Notifiation Script

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Mock Up	Yes	Yes	Fillable Fileable
Other-Interview Script	No		Fillable Fileable
Other-Notifiation Script	No		Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	167	167
Annual IC Cost Burden (Dollars)	0	0

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.

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