Att F_Varicella Outbreak Enhanced Data Collection Form - Maritime

[NCEZID] Contact Investigation Outcome Reporting Forms

Documents and Forms

Document Name Document Type
Form 0920-0900 Att F_Varicella Outbreak Enhanced Data Collection Form - Maritime Form
0920-0900 Varicella Outbreak Enhanced Data Collection Form - Marit Att. F-Varicella Investigation Outcome Reporting Form_final.docx Form
0920-0900 Varicella Outbreak Enhanced Data Collection Form - Marit Att. F-Varicella Investigation Outcome Reporting Form_final.docx Form

Information Collection (IC) Details

IC Title:	Att F_Varicella Outbreak Enhanced Data Collection Form - Maritime	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	Varicella Outbreak Enhanced Data Collection Form - Maritime	Att. F-Varicella Investigation Outcome Reporting Form_final.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Quarantine- and Traveler-Related Activities, Including Records for Contact Tracing Investigations	FR Citation: 72 FR 7086

Number of Respondents: 74	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	74	54	20
Annual IC Time Burden (Hours)	12	5	7
Annual IC Cost Burden (Dollars)	0	-249	249

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.