Information Collection

Varicella Investigation Outcome Reporting Form

IC 231142 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⚠️ Notice: This information collection may be referencing outdated material.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:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Varicella Investigation Outcome Reporting Form	Form
Varicella Investigation Outcome Reporting Form Attachment E Varicella Outbreak Cruise Ship EDC Form.docx	Form
Varicella Investigation Outcome Reporting Form Attachment E Varicella Outbreak Cruise Ship EDC Form.docx	Form

IC Title:

Varicella Investigation Outcome Reporting Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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	n/a	Varicella Investigation Outcome Reporting Form	Attachment E Varicella Outbreak Cruise Ship EDC Form.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Quarantine- and Traveler-Related Activities, Including Records for Contact Tracing Investigations

FR Citation: 72 FR 7086

Number of Respondents: 20

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	7	7
Annual IC Cost Burden (Dollars)	249	249

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.