Core Viral Hepatitis Outbreak Response and Surveillance Activities

Integrated Viral Hepatitis Surveillance and Prevention Funding for Health Departments

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1353 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-22AV Core Viral Hepatitis Outbreak Response and Surveillance Activities Form
0920-22AV Component 1: Core Viral Hepatitis Outbreak Response and Att 3a_Component 1_11-5-2021.docx Form
0920-22AV Component 1: Core Viral Hepatitis Outbreak Response and Att 3a_Component 1_11-5-2021.docx Form

Information Collection (IC) Details

IC Title:	Core Viral Hepatitis Outbreak Response and Surveillance Activities	Agency IC Tracking Number:	0920-21AV

Is this a Common Form? Yes		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	0920-22AV	Component 1: Core Viral Hepatitis Outbreak Response and Surveillance Activities	Att 3a_Component 1_11-5-2021.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 59	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	59	59
Annual IC Time Burden (Hours)	59	59
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.