2014014-XXX Ebola_Sierra Leone

Emergency Epidemic Investigation Data Collections - Expedited Reviews

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1011 can be found here:

Documents and Forms

Document Name Document Type
Appendix 1--CASE REPORT FORM.pdf Other-PDF
Appendix 2--CONTACT LISTING FORM.pdf Other-PDF
2014014-XXX_Ebola_Sierra Leone.docx Checklist 2014014-XXX_Ebola_Sierra Leone IC Document
InvitationFromSierraLeone.MANNING.jpg Invitational Letter (SierraLeone.Manning) IC Document
0920-1011 GenIC Request Ebola_Sierra Leone.msg E-mail Request IC Document

Information Collection (IC) Details

IC Title:	2014014-XXX Ebola_Sierra Leone	Agency IC Tracking Number:	0920-14AQD

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
Other-PDF			Appendix 1--CASE REPORT FORM.pdf		No		Fillable Printable
Other-PDF			Appendix 2--CONTACT LISTING FORM.pdf		No		Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,200	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	3,200	3,200
Annual IC Time Burden (Hours)	454	454
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Checklist 2014014-XXX_Ebola_Sierra Leone	2014014-XXX_Ebola_Sierra Leone.docx	07/21/2014
Invitational Letter (SierraLeone.Manning)	InvitationFromSierraLeone.MANNING.jpg	07/21/2014
E-mail Request	0920-1011 GenIC Request Ebola_Sierra Leone.msg	07/21/2014

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