Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Form (CRF)

[NCIRD] National Disease Surveillance Program - II. Disease Summaries

OMB: 0920-0004

IC ID: 258095

Information Collection (IC) Details

View Information Collection (IC)

Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Form (CRF)
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction n/a Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Form (CRF) Att GG Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Form (CRF).pdf Yes Yes Fillable Fileable

Health Public Health Monitoring

 

52 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 104 0 104 0 0 0
Annual IC Time Burden (Hours) 78 0 78 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.

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