EVD Tracking Form for Environmental Services Personnel

Ebola Virus Disease in the United States:CDC Support for Case and Contact Investigation

Documents and Forms

Document Name Document Type
EVD Tracking Form for Environmental Services Personnel Form and Instruction
Contact Trakcing Form for Environmental Services Personn Att5c Ebola Tracking Form for Environ Services Personnel.xlsx Form and Instruction

Information Collection (IC) Details

IC Title:	EVD Tracking Form for Environmental Services Personnel	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 and Instruction	None	Contact Trakcing Form for Environmental Services Personnel	Att5c Ebola Tracking Form for Environ Services Personnel.xlsx	None	Yes	Yes	Fillable Fileable

Line of Business: Disaster Management

Subfunction: Emergency Response

Privacy Act System of Records
Title: 09-20-0113, Epidemic Investigation Case Record Systems Notice	FR Citation: 51 FR 42466

Number of Respondents: 300	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 20 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,500	4,500
Annual IC Time Burden (Hours)	750	750
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.