Information Collection

(drss) Concession/partner Employee Illness Report

IC 236925 under ICR 202303-1024-001 · OMB 1024-0286.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form NPS Form 10-685 (DRSS) CONCESSION/PARTNER EMPLOYEE ILLNESS REPORT	Form
NPS Form 10-685 DISEASE REPORTING AND SURVEILLANCE SYSTEM (DRSS) CONCESS NPS 10-685 DRSS CONCESSION EMPLOYEE ILLNESS REPORT. (V3.2.2023).pdf	Form
NPS Form 10-685 DISEASE REPORTING AND SURVEILLANCE SYSTEM (DRSS) CONCESS NPS 10-685 DRSS CONCESSION EMPLOYEE ILLNESS REPORT. (V3.2.2023).pdf	Form

IC Title:

(DRSS) CONCESSION/PARTNER EMPLOYEE ILLNESS REPORT

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	NPS Form 10-685	DISEASE REPORTING AND SURVEILLANCE SYSTEM (DRSS) CONCESSION/PARTNER EMPLOYEE ILLNESS REPORT	NPS 10-685 DRSS CONCESSION EMPLOYEE ILLNESS REPORT. (V3.2.2023).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: 500

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	500	200	300
Annual IC Time Burden (Hours)	83	33	50
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.