Information Collection Request

[NCEZID] Information Collection for Tuberculosis Data from Referring Entities to CureTB

ICR 202402-0920-003 · OMB 0920-1186 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 0920-1186 CureTB Partner Feedback Form and Instruction Modified Available
Form 0920-1186 CureTB Partner Feedback (Satsifaction Assessment) Questionnaire 2 Form and Instruction Modified Repair queued
Form 0920-1186 CureTB Partner Feedback Form and Instruction Modified Available
Form 0920-1186 CureTB Partner Feedback (Satisfaction Assessment) Questionnaire 1 Form and Instruction Modified Repair queued
Form CS347315-A (02/01/ CureTB Transnational Notificaiton Form and Instruction Modified Available
Form CS347315-A (02/01/ CureTB Transnational Notification (TB patients referred by ICE) Form and Instruction Modified Repair queued
Form 0920-1186 Telephone Script for Clinician/Foreign Health Authority Referral Follow-up Form and Instruction Modified Available
Form 0920-1186 Telephone Script Clinician /Foreign Health Authority Follow-up (CureTB) Form and Instruction Modified Repair queued
Form CS347315-B (Revise CureTB Contact/Source Investigation (CI/SI) Notification Form and Instruction Modified Available
Form CS347315-B (Revise CureTB Contact/Source Investigation (CI/SI) Notification (USHD - local & state) Form and Instruction Modified Repair queued
Form CS347315-A (02/01/ CureTB Transnational Notification Form and Instruction Modified Available
Form CS347315-A (02/01/ CureTB Transnational Notification (TB patients referred by USHD) Form and Instruction Modified Repair queued
Form CS347315-A (02/01/ CureTB Transnational Notification Form and Instruction Modified Available
Form CS347315-A (02/01/ Cure TB Transnational Notification (referral from LHDs) Form and Instruction Modified Repair queued
Att. J-CureTB Notification Email.pdf Supplementary Document Uploaded 2024-02-21 Repair queued
Determination email to PIA (0920-1186).pdf Supplementary Document Uploaded 2024-02-09 Repair queued
Att. I- CureTB-PIA-Signed.pdf Supplementary Document Uploaded 2024-02-21 Repair queued
SSA_CureTB_022124_v2.docx Supporting Statement A Uploaded 2024-02-21 Repair queued
Att. H- Human Subjects Determination.pdf Supplementary Document Uploaded 2024-02-21 Repair queued
Att. B- Published 60-Day Federal Register Notice.pdf Supplementary Document Uploaded 2024-02-09 Repair queued
Att. A5 - Section 311.pdf Supplementary Document Uploaded 2020-06-08 Repair queued
Att. A4 - Section 301.pdf Supplementary Document Uploaded 2020-06-08 Repair queued
Att. A3 - 42 CFR Part 71.pdf Supplementary Document Uploaded 2020-06-08 Repair queued
Att. A2 - 42 CFR Part 70.pdf Supplementary Document Uploaded 2020-06-08 Repair queued
Att. A1 - Section 361 of the Public Health Service Act (42 USC 264).pdf Supplementary Document Uploaded 2020-06-08 Repair queued
Supporting Statement B_CureTB.docx Supporting Statement B Uploaded 2024-02-21 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
252225 CureTB Partner Feedback (Satsifaction Assessment) Questionnaire 2 Form and Instruction ModifiedCureTB Partner Feedback
252225 CureTB Partner Feedback (Satsifaction Assessment) Questionnaire 2 Form and Instruction Modified
252225 CureTB Partner Feedback (Satsifaction Assessment) Questionnaire 2 Other-Questionnaire annotated with skip logic Modified
252223 CureTB Partner Feedback (Satisfaction Assessment) Questionnaire 1 Form and Instruction ModifiedCureTB Partner Feedback
252223 CureTB Partner Feedback (Satisfaction Assessment) Questionnaire 1 Form and Instruction Modified
252223 CureTB Partner Feedback (Satisfaction Assessment) Questionnaire 1 Other-Questionnaire annotated with skip logic Modified
242057 CureTB Transnational Notification (TB patients referred by ICE) Form and Instruction ModifiedCureTB Transnational Notificaiton
242057 CureTB Transnational Notification (TB patients referred by ICE) Form and Instruction Modified
226739 Telephone Script Clinician /Foreign Health Authority Follow-up (CureTB) Form and Instruction ModifiedTelephone Script for Clinician/Foreign Health Authority Referral Follow-up
226739 Telephone Script Clinician /Foreign Health Authority Follow-up (CureTB) Form and Instruction Modified
226738 CureTB Contact/Source Investigation (CI/SI) Notification (USHD - local & state) Form and Instruction ModifiedCureTB Contact/Source Investigation (CI/SI) Notification
226738 CureTB Contact/Source Investigation (CI/SI) Notification (USHD - local & state) Form and Instruction Modified
226737 CureTB Transnational Notification (TB patients referred by USHD) Form and Instruction ModifiedCureTB Transnational Notification
226737 CureTB Transnational Notification (TB patients referred by USHD) Form and Instruction Modified
226736 Cure TB Transnational Notification (referral from LHDs) Form and Instruction ModifiedCureTB Transnational Notification
226736 Cure TB Transnational Notification (referral from LHDs) Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
05/31/2027 36 Months From Approved 05/31/2024
4,050 0 3,914
1,139 0 1,103
0 0 31,105





Reginfo record details
7
table that charts list of burden
IC Title Form No. Form Name
Cure TB Transnational Notification (referral from LHDs) CS347315-A (02/01/2024)
CureTB Contact/Source Investigation (CI/SI) Notification (USHD - local & state) CS347315-B (Revised 01/2024)
CureTB Partner Feedback (Satisfaction Assessment) Questionnaire 1 0920-1186
CureTB Partner Feedback (Satsifaction Assessment) Questionnaire 2 0920-1186
CureTB Transnational Notification (TB patients referred by ICE) CS347315-A (02/01/2024)
CureTB Transnational Notification (TB patients referred by USHD) CS347315-A (02/01/2024)
Telephone Script Clinician /Foreign Health Authority Follow-up (CureTB) 0920-1186

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 4,050 3,914 0 136 0 0
Annual Time Burden (Hours) 1,139 1,103 0 36 0 0
Annual Cost Burden (Dollars) 0 31,105 0 -31,105 0 0


Reginfo record details
  No