Information Collection

Burkholderia multivorans Outbreak Investigation Case Report Form

IC 266503 under ICR 202502-0920-011 · OMB 0920-1430.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Burkholderia multivorans Outbreak Investigation Case Report Form	Form
Case Report Form (CRF) - B. multivorans Burkholderia multivorans Outbreak Investigation Case Report Form	Form
Form 0920-1430 B.multivorans Outbreak Investigation_CRF Burkholderia multivorans Outbreak Investigation Case Report Form	Form and Instruction
Case Report Form (CRF) - B. multivorans Attachment 3-CRF_Burkholderia_multivorans_OMB_0920-1430_24.4.8.pdf	Form
Case Report Form (CRF) - B. multivorans Attachment 3-CRF_Burkholderia_multivorans_OMB_0920-1430_24.4.8.pdf	Form
0920-1430 B.multivorans Outbreak Investigation_CRF CRF_Burkholderia_multivorans_26FEB2025_clean.pdf	Form and Instruction
0920-1430 B.multivorans Outbreak Investigation_CRF CRF_Burkholderia_multivorans_26FEB2025_clean.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

0920-1430

Is this a Common Form? No

IC Status: Modified

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	N/A			N/A	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1430			N/A	Yes	Yes	Fillable Fileable

Line of Business: Disaster Management

Subfunction: Emergency Response

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 40

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	40	40
Annual IC Time Burden (Hours)	120	120
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.

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