Telephone Script Clinician /Foreign Health Authority Follow-up (CureTB)

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

Documents and Forms

Document Name Document Type
Form 0920-1186 Telephone Script Clinician /Foreign Health Authority Follow-up (CureTB) Form and Instruction
0920-1186 Telephone Script for Clinician/Foreign Health Authority Att. E- CureTB Clinician_PHD Follow-up script.docx Form and Instruction
0920-1186 Telephone Script for Clinician/Foreign Health Authority Att. E- CureTB Clinician_PHD Follow-up script.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Telephone Script Clinician /Foreign Health Authority Follow-up (CureTB)	Agency IC Tracking Number:	0920-1186

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-1186	Telephone Script for Clinician/Foreign Health Authority Referral Follow-up	Att. E- CureTB Clinician_PHD Follow-up script.docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0171, Quarantine- and Traveler-related Activities Including Records for Contact Tracing Investigation and Notification under 42 CFR Parts 70 and 71	FR Citation: 72 FR 70867

Number of Respondents: 900	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2,700	90	2,610
Annual IC Time Burden (Hours)	450	15	435
Annual IC Cost Burden (Dollars)	0	-10,279	10,279

Documents for IC

Title	Document	Date Uploaded
No associated records found

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