Information Collection

Aggregate counts of persons exposed to Highly Pathogenic Avian Influenza (HPAI

IC 258093 under ICR 202405-0920-001 · OMB 0920-0004.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0004 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Aggregate counts of persons exposed to Highly Pathogenic Avian Influenza (HPAI	Form and Instruction
Aggregate counts of persons exposed to Highly Pathogenic Avian Influenza (HPAI	Form and Instruction
Aggregate case counts of person exposed to Highly Pathog Att EE Aggregate case counts of persons exposed to Highly Pathogenic Avian Influenza (HPAI).pdf	Form and Instruction
Aggregate case counts of person exposed to Highly Pathog Att EE Aggregate case counts of persons exposed to Highly Pathogenic Avian Influenza (HPAI).pdf	Form and Instruction
0920-0004 Aggregate counts of persons exposed to highly pathogenic Attachment EE_Aggregate counts of persons exposed to highly pathogenic avian influenza_HPAI.docx	Form and Instruction
0920-0004 Aggregate counts of persons exposed to highly pathogenic Attachment EE_Aggregate counts of persons exposed to highly pathogenic avian influenza_HPAI.docx	Form and Instruction

IC Title:

Aggregate counts of persons exposed to Highly Pathogenic Avian Influenza (HPAI

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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 and Instruction	n/a	Aggregate case counts of person exposed to Highly Pathogenic Avian Influenza (HPAI)	Att EE Aggregate case counts of persons exposed to Highly Pathogenic Avian Influenza (HPAI).pdf		Yes	Yes	Fillable Fileable
Form and Instruction	0920-0004	Aggregate counts of persons exposed to highly pathogenic avian influenza HPAI_06MAY2024	Attachment EE_Aggregate counts of persons exposed to highly pathogenic avian influenza_HPAI.docx	N/A	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 52

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	Previously Approved
Annual Number of Responses for this IC	2,704	2,704
Annual IC Time Burden (Hours)	451	451
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.