Contact Investigation Outcome Reporting Forms

OMB 0920-0900

OMB 0920-0900

The purpose of this information collection is to obtain sufficient information on the results of contact investigations carried out by state and local public health professionals or maritime medical crews to assess the impact of a confirmed communicable disease of public health concern in a traveler. Information is used to assess the impact in terms of spread and health outcomes and to determine if further public health intervention is appropriate. Communicable diseases of interest include clinically active tuberculosis (TB), varicella, influenza-like illness, measles, and rubella. The purpose of this non-substantive Change Request (submitted August 2018) is to clarify the wording of selected questions on the ILI Outbreak Enhanced Data Collection Form.

The latest form for Contact Investigation Outcome Reporting Forms expires 2021-05-31 and can be found here.

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OMB Details

State/Local General Contact Reporting (Land)

Federal Enterprise Architecture: Health - Public Health Monitoring

Form n/aGeneral Contact Investigation Outcome Reporting Form (Land)Fillable FileableForm

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