Information Collection

State/Local TB Outcoming Reporting (Air)

IC 197946 under ICR 202111-0920-004 · OMB 0920-0900.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0900 can be found here:

2024-08-20 - Revision of a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0900 State/Local TB Outcoming Reporting (Air)	Form
0920-0900 TB Contact Investigation Outcome Reporting Form - Air TB Contact Investigation Outcome Reporting Form_Air_rev10.2021.pdf	Form
0920-0900 TB Contact Investigation Outcome Reporting Form - Air TB Contact Investigation Outcome Reporting Form_Air_rev10.2021.pdf	Form
TB Contact Investigation Outcome Reporting Form_Air_redline.docx TB Air Contact Investigation Outcome Reporting Form (redline)	IC Document
TB Contact Investigation Outcome Reporting Form_Air_redline.docx TB Air Contact Investigation Outcome Reporting Form (redline)	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

State/Local TB Outcoming Reporting (Air)

Agency IC Tracking Number:

0920-0900-22AK

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	0920-0900	TB Contact Investigation Outcome Reporting Form - Air	TB Contact Investigation Outcome Reporting Form_Air_rev10.2021.pdf		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 0920-0171 Quarantine and Traveler Related Activities, Including Records for Cpmtact Tracing Investigation and Notification under 42 CFR Parts 70 and 71

FR Citation: 72 FR 70867

Number of Respondents: 38

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
	Approved	Previously Approved
Annual Number of Responses for this IC	38	38
Annual IC Time Burden (Hours)	3	3
Annual IC Cost Burden (Dollars)	118	118

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
TB Air Contact Investigation Outcome Reporting Form (redline)	TB Contact Investigation Outcome Reporting Form_Air_redline.docx	11/01/2021

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