Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Short Form

[NCIRD] National Disease Surveillance Program - II. Disease Summaries

Documents and Forms

Document Name Document Type
Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Short Form Form and Instruction
Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Short Form Form and Instruction
Pediatric Hepatitis of Unknown Etiology Medical Record A Att FF Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Short Form .pdf Form and Instruction
Pediatric Hepatitis of Unknown Etiology Medical Record A Att FF Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Short Form .pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Short Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

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	n/a	Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Short Form	Att FF Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Short Form .pdf		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 %

	Approved	Previously Approved
Annual Number of Responses for this IC	208	208
Annual IC Time Burden (Hours)	52	52
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.