Information Collection

EDN TB Follow-up Worksheet

IC 231229 under ICR 202106-0920-012 · OMB 0920-1238.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1238 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-1238 EDN TB Follow-up Worksheet Form
0920-1238 The EDN Tuberculosis Follow-up Worksheet for Newly Arriv Att 3_2021 EDN TB Follow-Up Worksheet_FINAL.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	EDN TB Follow-up Worksheet	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	0920-1238	The EDN Tuberculosis Follow-up Worksheet for Newly Arrived Persons with Overseas Tuberculosis Classifications	Att 3_2021 EDN TB Follow-Up Worksheet_FINAL.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Alien Tuberculosis Follow-up Program	FR Citation: 51 FR 42462

Number of Respondents: 1,548	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	4,644	-21,756	26,400
Annual IC Time Burden (Hours)	2,322	-10,878	13,200
Annual IC Cost Burden (Dollars)	86,796	-406,620	493,416

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.