OMB control number

Surveillance Data Collections for Ebola Virus Disease in West Africa

OMB 0920-1085 · HHS/CDC.

OMB 0920-1085

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Health Facility Assessment and Case Finding Study - Arabic	Form and Instruction
Health Facility Assessment and Case Finding Study - Portuguese	Form and Instruction
Health Facility Assessment and Case Finding Study - French	Form and Instruction
Health Facility Assessment and Case Finding Study - English	Form and Instruction
Health Care Worker EVD Exposure Risk Reporting Form - Sierra Leone	Form and Instruction
Health Care Worker Ebola Virus Investigation Questionnaire - Liberia	Form and Instruction
Health Care Worker EVD Exposure Risk - Arabic	Form
Health Care Worker EVD Exposure Risk - Portuguese	Form
Health Care Worker EVD Exposure Risk - French	Form
Health Care Worker EVD Exposure Risk - English	Form
Ebola Sexual Transmission Investigation Form - Arabic	Form and Instruction
Ebola Sexual Transmission Investigation Form - Portuguese	Form and Instruction
Ebola Sexual Transmission Investigation Form - French	Form and Instruction
Ebola Sexual Transmission Investigation Form - English	Form and Instruction
EVD Case Contact Questionnaire - Arabic	Form and Instruction
EVD Case Contact Questionnaire - Portuguese	Form and Instruction
EVD Case Contact Questionnaire - French	Form and Instruction
EVD Case Contact Questionnaire - English	Form and Instruction
VHF Contact Tracing Follow-Up Form - Arabic	Form
VHF Contact Tracing Follow-Up Form - Portuguese	Form
VHF Contact Tracing Follow-Up Form - French	Form
VHF Contact Tracing Follow-Up Form - English	Form
VHF Contact Listing Form - Arabic	Form
VHF Contact Listing Form - Portuguese	Form
VHF Contact Listing Form - French	Form
VHF Contact Listing Form - English	Form
VHF Case Investigation Form - Arabic	Form and Instruction
VHF Case Investigation Form - Portuguese	Form and Instruction
VHF Case Investigation Form - French	Form and Instruction
VHF Case Investigation Form - English	Form and Instruction
VHF Case Investigation (Short Form) - Arabic	Form and Instruction
VHF Case Investigation (Short Form) - Portuguese	Form and Instruction
VHF Case Investigation (Short Form) - French	Form and Instruction
VHF Case Investigation (Short Form) - English	Form and Instruction
SupStmnt A Survllnc Data Collctn EVD West Africa 20150621.docx	Supporting Statement A
AppndxD West Africa Defn Burden Wage Est 20150621.docx	Supplementary Document
AppndxC EVDOutbrksChronology.pdf	Supplementary Document
AppndxC 2014 EVDGeoDistrbtn.pdf	Supplementary Document
AppndxB 60 day FRN 20150327.pdf	Supplementary Document
AppndxA Auth Legisltn 42 CFR 241.pdf	Supplementary Document
SupStmnt B Survllnc Data Collctn EVD West Africa 20150621.docx	Supporting Statement B
Health Facility Assessment and Case Finding Study - Arabic	Form and Instruction
Health Facility Assessment and Case Finding Study - Portuguese	Form and Instruction
Health Facility Assessment and Case Finding Study - French	Form and Instruction
Health Facility Assessment and Case Finding Study - English	Form and Instruction
Health Care Worker EVD Exposure Risk Reporting Form - Sierra Leone	Form and Instruction
Health Care Worker Ebola Virus Investigation Questionnaire - Liberia	Form and Instruction
Health Care Worker EVD Exposure Risk - Arabic	Form
Health Care Worker EVD Exposure Risk - Portuguese	Form
Health Care Worker EVD Exposure Risk - French	Form
Health Care Worker EVD Exposure Risk - English	Form
Ebola Sexual Transmission Investigation Form - Arabic	Form and Instruction
Ebola Sexual Transmission Investigation Form - Portuguese	Form and Instruction
Ebola Sexual Transmission Investigation Form - French	Form and Instruction
Ebola Sexual Transmission Investigation Form - English	Form and Instruction
EVD Case Contact Questionnaire - Arabic	Form and Instruction
EVD Case Contact Questionnaire - Portuguese	Form and Instruction
EVD Case Contact Questionnaire - French	Form and Instruction
EVD Case Contact Questionnaire - English	Form and Instruction
VHF Contact Tracing Follow-Up Form - Arabic	Form
VHF Contact Tracing Follow-Up Form - Portuguese	Form
VHF Contact Tracing Follow-Up Form - French	Form
VHF Contact Tracing Follow-Up Form - English	Form
VHF Contact Listing Form - Arabic	Form
VHF Contact Listing Form - Portuguese	Form
VHF Contact Listing Form - French	Form
VHF Contact Listing Form - English	Form
VHF Case Investigation Form - Arabic	Form and Instruction
VHF Case Investigation Form - Portuguese	Form and Instruction
VHF Case Investigation Form - French	Form and Instruction
VHF Case Investigation Form - English	Form and Instruction
VHF Case Investigation (Short Form) - Arabic	Form and Instruction
VHF Case Investigation (Short Form) - Portuguese	Form and Instruction
VHF Case Investigation (Short Form) - French	Form and Instruction
VHF Case Investigation (Short Form) - English	Form and Instruction

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Concluded	Action
201505-0920-008	New collection (Request for a new OMB Control Number)	2015-07-13		Approved without change