Information Collection

NPS Office of Public Health Case Investigation and Outbreak Form

IC 256157 under ICR 202209-1024-005 · OMB 1024-0289.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1024-0289 can be found here:

Documents and Forms

Document Name Document Type
NPS_EPI Form 10-4-2022.pdf Other-Questionnaire
NPS_EPI Form 3.24.2023.pdf Other-Questionnaire

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	NPS Office of Public Health Case Investigation and Outbreak Form	Agency IC Tracking Number:

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
Other-Questionnaire			NPS_EPI Form 3.24.2023.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 500	Number of Respondents for Small Entity: 100

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 95 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	167	167
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.