Information Collection

Chronic Q Fever Enhanced Surveillance (Follow-up0

IC 262134 under ICR 202309-0920-006 · OMB 0920-1305.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1305 Chronic Q Fever Enhanced Surveillance (Follow-up0	Form
Form 0920-1305 Chronic Q Fever - Enhanced Surveillance Follow-up Instrument Chronic Q Fever Enhanced Surveillance (Follow-up0	Form
0920-1305 Chronic Q Fever - Enhanced Surveillance Follow-up Instru Att 7 Chronic Q fever enhanced surveillance report form – Follow-up.pdf	Form
0920-1305 Chronic Q Fever - Enhanced Surveillance Follow-up Instru Att 7 Chronic Q fever enhanced surveillance report form – Follow-up.pdf	Form
Att 3 NNDSS Q Fever Case Definition.pdf NNDSS Q Fever Case Definition	IC Document
Att 3 NNDSS Q Fever Case Definition.pdf NNDSS Q Fever Case Definition	IC Document
Att 4 Supplemental Q Fever Case Report Form.pdf Supplemental Q Fever Case Report Form (CFR)	IC Document
Att 4 Supplemental Q Fever Case Report Form.pdf Supplemental Q Fever Case Report Form (CFR)	IC Document

IC Title:

Agency IC Tracking Number:

0920-1305

Is this a Common Form? No

IC Status: New

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	0920-1305				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

Number of Respondents for Small Entity: 0

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
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	17	17
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
NNDSS Q Fever Case Definition		09/13/2023
Supplemental Q Fever Case Report Form (CFR)		09/13/2023

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

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