Att 3e_Initial Outbreak Report Form

[NCCHSTP] Integrated Viral Hepatitis Surveillance and Prevention Funding for Health Departments

Documents and Forms

Document Name Document Type
Form 0920-1353 Att 3e_Initial Outbreak Report Form Form and Instruction
0920-1353 Initial Outbreak Report Form Att 3e_Outbreak Summary Report_5-18-2021_rev.docx Form and Instruction
0920-1353 Initial Outbreak Report Form Att 3e_Outbreak Summary Report_5-18-2021_rev.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Att 3e_Initial Outbreak Report Form	Agency IC Tracking Number:	0920-1353

Is this a Common Form? Yes		IC Status: Modified

Obligation to Respond: Mandatory

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	0920-1353	Initial Outbreak Report Form	Att 3e_Outbreak Summary Report_5-18-2021_rev.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 59	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	118	118
Annual IC Time Burden (Hours)	39	39
Annual IC Cost Burden (Dollars)	0	0

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.