Information Collection

Event Description Form

IC 234551 under ICR 202205-0930-001 · OMB 0930-0383.

Documents and Forms

Document Name Document Type
Form Event Description Event Description Form Form and Instruction
Event Description Event Description Form Attachment 1_TTC Event Description Form.doc Form and Instruction
Event Description Event Description Form Attachment 1_TTC Event Description Form.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Event Description Form	Agency IC Tracking Number:

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	Event Description Form	Event Description Form	Attachment 1_TTC Event Description Form.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 750	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	750	750
Annual IC Time Burden (Hours)	188	188
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.