Reporting Severe Adverse Events (Hospitalization or Death) Associated with Treatment of Latent Tuberculosis Infection (LTBI) - Physician

National Surveillance for Severe Adverse Events Associated with Treatment of Latent Tuberculosis Infection

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0773 can be found here:

Documents and Forms

Document Name Document Type
Reporting Severe Adverse Events (Hospitalization or Death) Associated with Treatment of Latent Tuberculosis Infection (LTBI) - Physician Form
Reporting Severe Adverse Events Associated with Treatmen Att 6 AdverseEvents Physcian LTBI NSSAE.docx Form

Information Collection (IC) Details

IC Title:	Reporting Severe Adverse Events (Hospitalization or Death) Associated with Treatment of Latent Tuberculosis Infection (LTBI) - Physician	Agency IC Tracking Number:

Is this a Common Form? No		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	Reporting Severe Adverse Events Associated with Treatment of Latent Tuberculosis Infection (LTBI) - Physician	Att 6 AdverseEvents Physcian LTBI NSSAE.docx	None	No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	10	10
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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