Information Collection

Viral Gastroenteritis Outbreak Submission Form

IC 178374 under ICR 202603-0920-014 · OMB 0920-0004.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Viral Gastroenteritis Outbreak Submission Form Viral Gastroenteritis Outbreak Submission Form	Form and Instruction
Viral Gastroenteritis Outbreak Submission Form Attachment Y Viral Gastroenteritis Outbreak Submission Form_final.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

0920-26-0150

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 and Instruction	n/a			NA	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Epidemiologic Studies and Surveillance of Disease Problems

FR Citation: 57 FR 62812

Number of Respondents: 20

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	8	8
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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