Cure TB Contact Source Investigation (CI/SI) Notification - LHD

Information Collection for Tuberculosis Data from Referring Entities to CureTB

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1186 can be found here:

Documents and Forms

Document Name Document Type
Cure TB Contact Source Investigation (CI/SI) Notification - LHD Form and Instruction
CureTB Contact/Source Investigation (CI/SI) Notification Att. D -CureTB Contact Source Investigation.pdf Form and Instruction
CureTB Contact/Source Investigation (CI/SI) Notification Att. D -CureTB Contact Source Investigation.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Cure TB Contact Source Investigation (CI/SI) Notification - LHD	Agency IC Tracking Number:	16AWE

Is this a Common Form? No		IC Status: Unchanged

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	n/a	CureTB Contact/Source Investigation (CI/SI) Notification	Att. D -CureTB Contact Source Investigation.pdf		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0171, Quarantine- and Traveler-related Activities Including Records for Contact Tracing Investigation and Notification under 42 CFR Parts 70 and 71	FR Citation: 72 FR 70867

Number of Respondents: 20	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Previously Approved
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	2,230	2,230

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.