Information Collection Request

ICR 202312-0970-003 · OMB 0970-0509 · Public filing

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0970-0509 can be found here:

2025-02-15 - No material or nonsubstantive change to a currently approved collection
2024-10-07 - No material or nonsubstantive change to a currently approved collection

Forms and Documents

Forms and supporting documents for this ICR
Document	Type	Status	Availability
Form 1 Public Health Investigation Form: Non-TB Illness - Recordkeeping Time	Form	Unchanged	Available
Form 1 Public Health Investigation Form: Non-TB Illness - Recordkeeping Time	Form	Unchanged	Available
Form 1 Public Health Investigation Form: Active TB - Recordkeeping Time	Form	Unchanged	Available
Form 1 Public Health Investigation Form: Active TB - Recordkeeping Time	Form	Unchanged	Repair queued
Form 1 Mental Health Assessment Form - Recordkeeping Time	Form	Modified	Available
Form 1 Mental Health Assessment Form - Recordkeeping Time	Form	Modified	Repair queued
Form 1 Public Health Investigation Form: Non-TB Illness - Reporting Time	Form	Unchanged	Available
Form 1 Public Health Investigation Form: Non-TB Illness - Reporting Time	Form	Unchanged	Available
Form 1 Public Health Investigation Form: Active TB - Reporting Time	Form	Unchanged	Available
Form 1 Public Health Investigation Form: Active TB - Reporting Time	Form	Unchanged	Repair queued
Form 1 Mental Health Assessment Form - Reporting Time	Form	Modified	Available
Form 1 Mental Health Assessment Form - Reporting Time	Form	Modified	Repair queued
NonSub Change Request - MH Assessment Form and PH Ivest Forms -ROCIS title.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2023-09-18	Available
NonSub Change Request - MH Assessment Form and PH Ivest Forms -ROCIS title.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2023-09-18	Repair queued
Supporting Statement A_Mental Health Assessment Form and Public Health Investigation Forms_fnl.docx	Supporting Statement A	Uploaded 2023-09-18	Available
Supporting Statement A_Mental Health Assessment Form and Public Health Investigation Forms_fnl.docx	Supporting Statement A	Uploaded 2023-09-18	Repair queued
Attachment B_Mental Health Assessment Form Instructional Letter for Mental Health Providers.docx	Supplementary Document	Uploaded 2023-08-03	Repair queued
Attachment B_Mental Health Assessment Form Instructional Letter for Mental Health Providers.docx	Supplementary Document	Uploaded 2023-08-03	Repair queued
Attachment A_Flores Agreement.docx	Supplementary Document	Uploaded 2023-08-03	Available
Attachment A_Flores Agreement.docx	Supplementary Document	Uploaded 2023-08-03	Repair queued

IC Document Collections

Information collection document groups
IC ID	Collection	Type	Status
261448	Public Health Investigation Form: Non-TB Illness - Recordkeeping Time	Form	Unchanged
261448	Public Health Investigation Form: Non-TB Illness - Recordkeeping Time	Form	Unchanged
261447	Public Health Investigation Form: Active TB - Recordkeeping Time	Form	Unchanged
261447	Public Health Investigation Form: Active TB - Recordkeeping Time	Form	Unchanged
261446	Mental Health Assessment Form - Recordkeeping Time	Form	Modified
261446	Mental Health Assessment Form - Recordkeeping Time	Form	Modified
229906	Public Health Investigation Form: Non-TB Illness - Reporting Time	Form	Unchanged
229906	Public Health Investigation Form: Non-TB Illness - Reporting Time	Form	Unchanged
229904	Public Health Investigation Form: Active TB - Reporting Time	Form	Unchanged
229904	Public Health Investigation Form: Active TB - Reporting Time	Form	Unchanged
229902	Mental Health Assessment Form - Reporting Time	Form	Modified
229902	Mental Health Assessment Form - Reporting Time	Form	Modified

ICR Details

Record metadata
OMB Control No	0970-0509