VHF Contact Tracing Follow-Up Form - English

Surveillance Data Collections for Ebola Virus Disease in West Africa

Documents and Forms

Document Name Document Type
VHF Contact Tracing Follow-Up Form - English Form
VHF Contact Tracing Follow-Up Form - English Att13 VHFContctTracngFollwUpForm ENG.docx Form

Information Collection (IC) Details

IC Title:	VHF Contact Tracing Follow-Up Form - English	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	VHF Contact Tracing Follow-Up Form - English	Att13 VHFContctTracngFollwUpForm ENG.docx	None	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 171,960	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 20 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	171,960	171,960
Annual IC Time Burden (Hours)	180,558	180,558
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.