OMB Approved
OMB Control No. 0920-XXXX
Exp XX/XX/XXXX
Placeholder for ROCIS.
This information collection is not a standard form. Respondents may send the agreement with the Healthcare Organization with signoff from the Local Health Authority in a format mutually agreed to by CDC and the respondents. CDC anticipates receiving this information primarily via email.
Public reporting burden of this collection of information is estimated to average 10 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB Control Number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA 0920-XXXX
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | De La Motte Hurst, Christopher (CDC/DDID/NCEZID/DGMQ) |
| File Modified | 0000-00-00 |
| File Created | 2023-09-04 |