Data Elements Transferred to CDC for the HAIC Death Ascertainment Project

[NCEZID] Emerging Infections Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0978 can be found here:

Documents and Forms

Document Name Document Type
Form HAIC.400.13 Data Elements Transferred to CDC for the HAIC Death Ascertainment Project Form and Instruction
HAIC.400.13 Data Elements Transferred to CDC for the HAIC Death Asce HAIC.400.13 HAIC Death Ascertainment Project.pdf Form and Instruction
HAIC.400.13 Data Elements Transferred to CDC for the HAIC Death Asce HAIC.400.13 HAIC Death Ascertainment Project.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Data Elements Transferred to CDC for the HAIC Death Ascertainment Project	Agency IC Tracking Number:	0920-0978

Is this a Common Form? No		IC Status: Modified

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	HAIC.400.13	Data Elements Transferred to CDC for the HAIC Death Ascertainment Project	HAIC.400.13 HAIC Death Ascertainment Project.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10	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	80	80
Annual IC Time Burden (Hours)	1,920	1,920
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.