State/Local TB Outcoming Reporting (Air)

Contact Investigation Outcome Reporting Forms

OMB: 0920-0900

IC ID: 197946

Documents and Forms
Document Name
Document Type
Form
Form
Form
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

State/Local TB Outcoming Reporting (Air) 0920-0900-22AK
 
No Modified
 
Voluntary
 

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

Health Public Health Monitoring

0920-0171 Quarantine and Traveler Related Activities, Including Records for Cpmtact Tracing Investigation and Notification under 42 CFR Parts 70 and 71  72 FR 70867

38 0
   
State, Local, and Tribal Governments
 
   100 %

  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 38 0 0 0 0 38
Annual IC Time Burden (Hours) 3 0 0 0 0 3
Annual IC Cost Burden (Dollars) 118 0 0 0 0 118

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.
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