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Viral Hemorrhagic Fever Case Investigation Form (Guinea 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: 213607
OMB.report
HHS/CDC
OMB 0920-1033
ICR 201501-0920-017
IC 213607
( )
Documents and Forms
Document Name
Document Type
Form 0920-15CN
Viral Hemorrhagic Fever Case Investigation Form (Guinea French)
Form and Instruction
0920-15CN Attachment B_Viral Hemorrhagic Fever Case Investigation
Attachment B_Viral Hemorrhagic Fever Case Investigation Form_Guinea_French.pdf
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Viral Hemorrhagic Fever Case Investigation Form (Guinea French)
Agency IC Tracking Number:
0920-15CN
Is this a Common Form?
No
IC Status:
Unchanged
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 B_Viral Hemorrhagic Fever Case Investigation Form_Guinea_French
Attachment B_Viral Hemorrhagic Fever Case Investigation Form_Guinea_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:
Ebola Emergency Investigation Case Records System Notice
FR Citation:
51 FR 42466
Number of Respondents:
4,000
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
4,000
0
0
0
0
4,000
Annual IC Time Burden (Hours)
1,333
0
0
0
0
1,333
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.