Information Collection

TB Land Contact Investigation Outcome Reporting Form

IC 279496 under ICR 202603-0920-008 · OMB 0920-0134.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Tuberculosis Land Conveyance Contact Investigation Outcome Reporting Form TB Land Contact Investigation Outcome Reporting Form	Form and Instruction
Tuberculosis Land Conveyance Contact Investigation Outco Attachment H - TB Land-Contact Investigation Outcome Reporting Form_final-CLEAN.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

0920-26-0139

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 and Instruction	n/a				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Quarantine and Travel Related Activities, Including Records for Contact Tracing

FR Citation: 72 FR 239

Number of Respondents: 20

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 99 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	3	3
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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