Information Collection

EDN TB Follow-up Worksheet

IC 231229 under ICR 202310-0920-005 · OMB 0920-1238.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1238 EDN TB Follow-up Worksheet	Form
0920-1238 The EDN Tuberculosis Follow-Up Worksheet for Newly-Arriv Att 3 2021 EDN TB Follow-Up Worksheet.pdf	Form
0920-1238 The EDN Tuberculosis Follow-Up Worksheet for Newly-Arriv Att 3 2021 EDN TB Follow-Up Worksheet.pdf	Form
0920-1238 EDN Tuberculosis Follow-Up Worksheet for Newly-Arrived P 2023 EDN TB Follow-Up Worksheet_Revised_Clean.docx	Form
0920-1238 EDN Tuberculosis Follow-Up Worksheet for Newly-Arrived P 2023 EDN TB Follow-Up Worksheet_Revised_Clean.docx	Form
Att 3a_Detailed Chart of Revisions on the 2021 EDN TB Follow-Up Worksheet.docx Revisions Made to The EDN Tuberculosis Follow-Up Worksheet	IC Document
Att 3a_Detailed Chart of Revisions on the 2021 EDN TB Follow-Up Worksheet.docx Revisions Made to The EDN Tuberculosis Follow-Up Worksheet	IC Document

IC Title:

Agency IC Tracking Number:

0920-1238

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	0920-1238	The EDN Tuberculosis Follow-Up Worksheet for Newly-Arrived Persons with Overseas Tuberculosis Classifications	Att 3 2021 EDN TB Follow-Up Worksheet.pdf		Yes	Yes	Fillable Fileable
Form	0920-1238	EDN Tuberculosis Follow-Up Worksheet for Newly-Arrived Persons with Overseas Tuberculosis Classifications - 12 OCT2023	2023 EDN TB Follow-Up Worksheet_Revised_Clean.docx	N/A	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Alien Tuberculosis Follow-up Program

FR Citation: 51 FR 42462

Number of Respondents: 2,262

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	9,048	9,048
Annual IC Time Burden (Hours)	4,524	4,524
Annual IC Cost Burden (Dollars)	169,107	169,107

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Revisions Made to The EDN Tuberculosis Follow-Up Worksheet	Att 3a_Detailed Chart of Revisions on the 2021 EDN TB Follow-Up Worksheet.docx	05/17/2022

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