Information Collection

Burkholderia multivorans Outbreak Investigation Case Report Form

IC 266503 under ICR 202404-0920-002 · OMB 0920-1430.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1430 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Burkholderia multivorans Outbreak Investigation Case Report Form	Form
Burkholderia multivorans Outbreak Investigation Case Report Form	Form
Case Report Form (CRF) - B. multivorans Attachment 3 - CRF_Burkholderia_multivorans.pdf	Form
Case Report Form (CRF) - B. multivorans Attachment 3 - CRF_Burkholderia_multivorans.pdf	Form

IC Title:

Burkholderia multivorans Outbreak Investigation Case Report Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

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	N/A	Case Report Form (CRF) - B. multivorans	Attachment 3 - CRF_Burkholderia_multivorans.pdf	N/A	Yes	Yes	Fillable Fileable

Line of Business: Disaster Management

Subfunction: Emergency Response

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 40

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
Annual Number of Responses for this IC	40	40
Annual IC Time Burden (Hours)	120	120
Annual IC Cost Burden (Dollars)	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.