Information Collection

Contact Tracing Survey

IC 271898 under ICR 202410-0920-025 · OMB 0920-1446.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1446 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-25AU Contact Tracing Survey	Form
0920-25AU Contact Tracing Survey Att. 6 Contact Tracing Survey_Revised.docx	Form

IC Title:

Contact Tracing Survey

Agency IC Tracking Number:

0920-25AU

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	0920-25AU	Contact Tracing Survey	Att. 6 Contact Tracing Survey_Revised.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	25	25
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.