Information Collection

One Health Case Investigation Form

IC 251605 under ICR 202202-0920-005 · OMB 0920-1371.

Documents and Forms

Document Name Document Type
Form 0920-21HD One Health Case Investigation Form Form and Instruction
0920-21HD One Health Case Investigation Form Att. E One Health Case Investigation Form for Animals with SARS-CoV-2 (Screenshots)_final.docx Form and Instruction
0920-21HD One Health Case Investigation Form Att. E One Health Case Investigation Form for Animals with SARS-CoV-2 (Screenshots)_final.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	One Health Case Investigation Form	Agency IC Tracking Number:	0920-21HD

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-21HD	One Health Case Investigation Form	Att. E One Health Case Investigation Form for Animals with SARS-CoV-2 (Screenshots)_final.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,000	1,000
Annual IC Time Burden (Hours)	1,000	1,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.