OMB control number

2014 Emergency Response to Ebola in West Africa: Data Collection for Assisting Foreign and International Entities to Conduct Public Health Activities

OMB 0920-1033 · HHS/CDC.

OMB 0920-1033

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form 0920-1033 Healthcare Worker- Ebola Virus Disease Exposure Risk Report - Sierra Leone	Form and Instruction
Form 0920-1033 Healthcare Worker-Ebola Virus Disease Investigation Questionnaire - Liberia	Form and Instruction
Form 0920-1033 Healhcare Worker-Ebola Virus Disease Exposure Risk Report (CDC/WHO) - French	Form and Instruction
Form 0920-1033 Healthcare Worker-Ebola Virus Disease Exposure Risk Report (CDC/WHO)	Form and Instruction
Form 0920-15CN Health Facility Assessment and Case Finding Survey	Form and Instruction
Form 0920-15CN Ebola Virus Disease Case Contact Questionnaire	Form and Instruction
Form 0920-15CN Viral Hemorrhagic Fever Contact Tracing Follow-Up Form	Form and Instruction
Form 0920-15CN Viral Hemorrhagic Fever Contact Listing Form (Liberia)	Form and Instruction
Form 0920-15CN Viral Hemorrhagic Fever Contact Listing Form (Guinea French)	Form and Instruction
Form 0920-15CN Viral Hemorrhagic Fever Contact Listing Form (Senegal French)	Form and Instruction
Form 0920-15CN Viral Hemorrhagic Fever Contact Listing Form (General)	Form and Instruction
Form 0920-15CN Viral Hemorrhagic Fever Case Investigation Form (Short Version Liberia)	Form and Instruction
Form 0920-15CN Viral Hemorrhagic Fever Case Investigation Form (Nigeria)	Form and Instruction
Form 0920-15CN Viral Hemorrhagic Fever Case Investigation Form (Sierra Leone)	Form and Instruction
Form 0920-15CN Viral Hemorrhagic Fever Case Investigation Form (Liberia)	Form and Instruction
Form 0920-15CN Viral Hemorrhagic Fever Case Investigation Form (Senegal French)	Form and Instruction
Form 0920-15CN Viral Hemorrhagic Fever Case Investigation Form (Guinea French)	Form and Instruction
non-Substantive Change Request to 0920-1033 1-14-15.docx	Justification for No Material/Nonsubstantive Change
Attachment O_Ebola Virus Epi Invest SORN_10-06-2014.doc	Supplementary Document
International_Ebola Emergency Clearance SSA Final.docx	Supporting Statement B
International_Ebola Emergency Clearance SSA Final.docx	Supporting Statement A
Healthcare Worker- Ebola Virus Disease Exposure Risk Report - Sierra Leone	Form and Instruction
Healthcare Worker-Ebola Virus Disease Investigation Questionnaire - Liberia	Form and Instruction
Healhcare Worker-Ebola Virus Disease Exposure Risk Report (CDC/WHO) - French	Form and Instruction
Healthcare Worker-Ebola Virus Disease Exposure Risk Report (CDC/WHO)	Form and Instruction
Health Facility Assessment and Case Finding Survey	Form and Instruction
Ebola Virus Disease Case Contact Questionnaire	Form and Instruction
Viral Hemorrhagic Fever Contact Tracing Follow-Up Form	Form and Instruction
Viral Hemorrhagic Fever Contact Listing Form (Liberia)	Form and Instruction
Viral Hemorrhagic Fever Contact Listing Form (Guinea French)	Form and Instruction
Viral Hemorrhagic Fever Contact Listing Form (Senegal French)	Form and Instruction
Viral Hemorrhagic Fever Contact Listing Form (General)	Form and Instruction
Viral Hemorrhagic Fever Case Investigation Form (Short Version Liberia)	Form and Instruction
Viral Hemorrhagic Fever Case Investigation Form (Nigeria)	Form and Instruction
Viral Hemorrhagic Fever Case Investigation Form (Sierra Leone)	Form and Instruction
Viral Hemorrhagic Fever Case Investigation Form (Liberia)	Form and Instruction
Viral Hemorrhagic Fever Case Investigation Form (Senegal French)	Form and Instruction
Viral Hemorrhagic Fever Case Investigation Form (Guinea French)	Form and Instruction

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Concluded	Action
201501-0920-017	No material or nonsubstantive change to a currently approved collection	2015-01-16		Approved without change
201410-0920-027	New collection (Request for a new OMB Control Number)	2014-10-24		Approved without change