Information Collection

Disease Transmission Event

IC 251645 under ICR 202506-0915-004 · OMB 0915-0157.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 58 Disease Transmission Event_Form.xlsx Disease Transmission Event	Form
58. Disease Transmission Event_Instructions.docx	Instruction
58. Disease Transmission Event_Instructions.docx	Instruction
58. Disease Transmission Event_Form_redline.xlsx	Other-Redline
58. Disease Transmission Event_Form_redline.xlsx	Other-Redline
58 Disease Transmission Event_Form.xlsx 58. Disease Transmission Event_Form_clean.xlsx	Form
58 Disease Transmission Event_Form.xlsx 58. Disease Transmission Event_Form_clean.xlsx	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction		Yes	Yes	Fillable Fileable
Form	58	Yes	Yes	Fillable Fileable
Other-Redline		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: Privacy Act System of Records Notice #09-15-0055

FR Citation: 87 FR 46967

Number of Respondents: 304

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	708	151	557
Annual IC Time Burden (Hours)	425	80	345
Annual IC Cost Burden (Dollars)	0	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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