Att G_Influenza Outbreak Enhanced Data Collection Form – Maritime

[NCEZID] Contact Investigation Outcome Reporting Forms

Documents and Forms

Document Name Document Type
Form 0920-0900 Att G_Influenza Outbreak Enhanced Data Collection Form – Maritime Form and Instruction
0920-0900 Influenza Outbreak Enhanced Data Collection Form – Marit Att. G-Influenza Outbreak Enhanced Data Collection Form – Maritime_final.docx Form and Instruction
0920-0900 Influenza Outbreak Enhanced Data Collection Form – Marit Att. G-Influenza Outbreak Enhanced Data Collection Form – Maritime_final.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Att G_Influenza 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 and Instruction	0920-0900	Influenza Outbreak Enhanced Data Collection Form – Maritime	Att. G-Influenza Outbreak Enhanced Data Collection Form – Maritime_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: 10	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	10	-20	30
Annual IC Time Burden (Hours)	2	-8	10
Annual IC Cost Burden (Dollars)	0	-374	374

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.