Att L_General Land Contact Investigation Outcome Reporting Form

[NCEZID] Contact Investigation Outcome Reporting Forms

Documents and Forms

Document Name Document Type
Form 0920-0900 Att L_General Land Contact Investigation Outcome Reporting Form Form
0920-0900 General Land Contact Investigation Outcome Reporting For Att. L-General Land Contact Investigation Outcome Reporting Form_final.docx Form
0920-0900 General Land Contact Investigation Outcome Reporting For Att. L-General Land Contact Investigation Outcome Reporting Form_final.docx Form

Information Collection (IC) Details

IC Title:	Att L_General Land Contact Investigation Outcome Reporting Form	Agency IC Tracking Number:	0920-0900

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	0920-0900	General Land Contact Investigation Outcome Reporting Form	Att. L-General Land Contact Investigation Outcome Reporting Form_final.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 0920-0171 Quarantine and Traveler Related Activities, Including Records for Cpmtact Tracing Investigation and Notification under 42 CFR Parts 70 and 71	FR Citation: 72 FR 70867

Number of Respondents: 2	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2	-13	15
Annual IC Time Burden (Hours)	0	-1	1
Annual IC Cost Burden (Dollars)	0	-47	47

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.