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Viral Hemorrhagic Fever Contact Listing Form (Senegal French)
2014 Emergency Response to Ebola in West Africa: Data Collection for Assisting Foreign and International Entities to Conduct Public Health Activities
OMB: 0920-1033
IC ID: 213616
OMB.report
HHS/CDC
OMB 0920-1033
ICR 201410-0920-027
IC 213616
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1033 can be found here:
2015-01-16 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Form 0920-15CN
Viral Hemorrhagic Fever Contact Listing Form (Senegal French)
Form and Instruction
0920-15CN Attachment I_Viral Hemorrhagic Fever Contact Listing For
Attachment I_Viral Hemorrhagic Fever Contact Listing Form_Senegal_French.pdf
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Viral Hemorrhagic Fever Contact Listing Form (Senegal French)
Agency IC Tracking Number:
0920-15CN)
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 and Instruction
0920-15CN
Attachment I_Viral Hemorrhagic Fever Contact Listing Form_Senegal_French
Attachment I_Viral Hemorrhagic Fever Contact Listing Form_Senegal_French.pdf
Yes
No
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
500
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
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
500
0
500
0
0
0
Annual IC Time Burden (Hours)
125
0
125
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
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.