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Management of Fever in Travelers from Ebola Affected and Ebola Non-affected Malaria Endemic Countries
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NCIRD)
OMB: 0920-1026
IC ID: 215587
OMB.report
HHS/CDC
OMB 0920-1026
ICR 201407-0920-001
IC 215587
( )
Documents and Forms
Document Name
Document Type
Management of Fever in Travelers from Ebola Affected and Ebola Non-affected Malaria Endemic Countries
Form
Assessment for Health Depts
Attachment A_Ebola_Malaria_Assessment_Health Department.docx
Form
Assessment for Health Facilities
Attachment B_Ebola_Malaria_Assessment_Health Facility.docx
Form
0920 1026_ Malaria_Ebola_GenIC_final.docx
Request for Approval
IC Document
Attachment C_PhoneScripts.docx
Telephone Script
IC Document
Attachment D_Population Diagram.docx
Population Diagram
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Management of Fever in Travelers from Ebola Affected and Ebola Non-affected Malaria Endemic Countries
Agency IC Tracking Number:
15SY
IC Status:
New
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
none
Assessment for Health Depts
Attachment A_Ebola_Malaria_Assessment_Health Department.docx
No
Paper Only
Form
none
Assessment for Health Facilities
Attachment B_Ebola_Malaria_Assessment_Health Facility.docx
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
264
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
264
0
264
0
0
0
Annual IC Time Burden (Hours)
61
0
61
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Request for Approval
0920 1026_ Malaria_Ebola_GenIC_final.docx
03/06/2015
Telephone Script
Attachment C_PhoneScripts.docx
03/06/2015
Population Diagram
Attachment D_Population Diagram.docx
03/06/2015
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.