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Federal forms, ICRs, and supporting documents

Information Collection

Student Component- Acute Respiratory Infection and Influenza Surveillance Form (Parents of >18)

IC 212417 under ICR 202108-0920-002 · OMB 0920-1039.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
18) Form
Acute Respiratory Infection and Influenza Surveillance Form Student Component- Acute Respiratory Infection and Influenza Surveillance Form (Parents of >18) Form
Acute Respiratory Infection and Influenza Surveillance F
Att. C4 - Acute Respiratory Infection and Influenza Surveillance Form.docx 		Form
Acute Respiratory Infection and Influenza Surveillance F
Att. C4 - Acute Respiratory Infection and Influenza Surveillance Form.docx 		Form

Information Collection (IC) Details

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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 NA Acute Respiratory Infection and Influenza Surveillance Form Att. C4 - Acute Respiratory Infection and Influenza Surveillance Form.docx NA No   Paper Only

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  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 300 0 0 0 300 0
Annual IC Time Burden (Hours) 75 0 0 0 75 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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