Information Collection

Aggregate counts of persons exposed to Highly Pathogenic Avian Influenza (HPAI

IC 258093 under ICR 202512-0920-005 · OMB 0920-0004.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0004 can be found here:

Documents and Forms

Document Name Document Type
Aggregate counts of persons exposed to Highly Pathogenic Avian Influenza (HPAI Form and Instruction
Aggregate case counts of person exposed to Highly Pathogenic Avian Influenza (HPAI) Aggregate counts of persons exposed to Highly Pathogenic Avian Influenza (HPAI Form and Instruction
Form 0920-0004 Aggregate counts of persons exposed to highly pathogenic avian influenza HPAI_06MAY2024 Aggregate counts of persons exposed to Highly Pathogenic Avian Influenza (HPAI Form and Instruction
Aggregate case counts of person exposed to Highly Pathog Att EE Aggregate case counts of persons exposed to Highly Pathogenic Avian Influenza (HPAI).pdf Form and Instruction
Aggregate case counts of person exposed to Highly Pathog Att EE Aggregate case counts of persons exposed to Highly Pathogenic Avian Influenza (HPAI).pdf Form and Instruction
0920-0004 Aggregate counts of persons exposed to highly pathogenic Attachment EE_Aggregate counts of persons exposed to highly pathogenic avian influenza_HPAI.docx Form and Instruction
0920-0004 Aggregate counts of persons exposed to highly pathogenic Attachment EE_Aggregate counts of persons exposed to highly pathogenic avian influenza_HPAI.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Aggregate counts of persons exposed to Highly Pathogenic Avian Influenza (HPAI	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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	n/a	Aggregate case counts of person exposed to Highly Pathogenic Avian Influenza (HPAI)	Att EE Aggregate case counts of persons exposed to Highly Pathogenic Avian Influenza (HPAI).pdf		Yes	Yes	Fillable Fileable
Form and Instruction	0920-0004	Aggregate counts of persons exposed to highly pathogenic avian influenza HPAI_06MAY2024	Attachment EE_Aggregate counts of persons exposed to highly pathogenic avian influenza_HPAI.docx	N/A	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 52	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	2,704	2,704
Annual IC Time Burden (Hours)	451	451
Annual IC Cost Burden (Dollars)	0	0

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.

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