att 3f_Outbreak Summary Report Form

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

Documents and Forms

Document Name Document Type
Form 0920-1353 att 3f_Outbreak Summary Report Form Form
0920-1353 Outbreak Summary Report Form Att 3f_Acute Viral Hepatitis Case Reporting_6-9-2021.docx Form
0920-1353 Outbreak Summary Report Form Att 3f_Acute Viral Hepatitis Case Reporting_6-9-2021.docx Form

Information Collection (IC) Details

IC Title:	att 3f_Outbreak Summary 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	0920-1353	Outbreak Summary Report Form	Att 3f_Acute Viral Hepatitis Case Reporting_6-9-2021.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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	118	59	59
Annual IC Time Burden (Hours)	39	10	29
Annual IC Cost Burden (Dollars)	0	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.