Information Collection

att 3f_Outbreak Summary Report Form

IC 248662 under ICR 202403-0920-014 · OMB 0920-1353.

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Agency IC Tracking Number:

0920-1353

Is this a Common Form? Yes

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.