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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

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.