MPEP Mycobacterium Tuberculosis Results

CDC Model Performance Evaluation Program (MPEP) for Mycobacterium tuberculosis and Nontuberculous Mycobacteria Drug Susceptibility Testing

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0600 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-0600 MPEP Mycobacterium Tuberculosis Results Form and Instruction
MPEP M tuberculosis worksheet changes reflected.docx Instruction
0920-0600 Att C M tuberculosis Results Worksheet Att C M tuberculosis Results Worksheet.docx Form and Instruction
Att E Preshipment Email_page 1.docx Att E Preshipment Email_page 1 IC Document
Att F Instructions for particpants.docx Att F Instructions for particpants IC Document
Att I Reminder Email.docx Att I Reminder Email IC Document
Att J Reminder Telephone Script.docx Att J Reminder Telephone Script IC Document
Att K Aggregate Report Letter.docx Att K Aggregate Report Letter IC Document
Att L Final Aggregate Report.pdf Att L Final Aggregate Report IC Document

Information Collection (IC) Details

IC Title:	MPEP Mycobacterium Tuberculosis Results	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-0600	Att C M tuberculosis Results Worksheet	Att C M tuberculosis Results Worksheet.docx		Yes	Yes	Fillable Fileable
Instruction			MPEP M tuberculosis worksheet changes reflected.docx		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 93	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	186	186
Annual IC Time Burden (Hours)	93	93
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att E Preshipment Email_page 1	Att E Preshipment Email_page 1.docx	04/22/2013
Att F Instructions for particpants	Att F Instructions for particpants.docx	04/22/2013
Att I Reminder Email	Att I Reminder Email.docx	04/22/2013
Att J Reminder Telephone Script	Att J Reminder Telephone Script.docx	04/22/2013
Att K Aggregate Report Letter	Att K Aggregate Report Letter.docx	04/22/2013
Att L Final Aggregate Report	Att L Final Aggregate Report.pdf	04/22/2013

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.