Outbreak Summary Report Form

Integrated Viral Hepatitis Surveillance and Prevention Funding for Health Departments

OMB: 0920-1353

IC ID: 248661

Information Collection (IC) Details

View Information Collection (IC)

Outbreak Summary Report Form 0920-21EE
 
Yes Unchanged
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-21EE Att 3e_Outbreak Summary Report Att 3e_Outbreak Summary Report_5-18-2021_rev.docx Yes Yes Fillable Fileable

Health Illness Prevention

 

59 0
   
State, Local, and Tribal Governments
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 118 0 0 0 0 118
Annual IC Time Burden (Hours) 39 0 0 0 0 39
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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