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Chronic Q Fever Enhanced Surveillance (Follow-up0

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

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Chronic Q Fever Enhanced Surveillance (Follow-up0 0920-1305
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 0920-1305 Chronic Q Fever - Enhanced Surveillance Follow-up Instrument Att 7 Chronic Q fever enhanced surveillance report form – Follow-up.pdf Yes Yes Fillable Fileable

Health Public Health Monitoring

 

50 0
   
Individuals or Households
 
   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 50 0 0 50 0 0
Annual IC Time Burden (Hours) 17 0 0 17 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
NNDSS Q Fever Case Definition Att 3 NNDSS Q Fever Case Definition.pdf 09/13/2023
Supplemental Q Fever Case Report Form (CFR) Att 4 Supplemental Q Fever Case Report Form.pdf 09/13/2023
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.