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Clinician Public Health Department Follow-Up Script - TB Treating Physicians
Information Collection for Tuberculosis Data from Referring Entities to Cure TB
OMB: 0920-1186
IC ID: 226739
OMB.report
HHS/CDC
OMB 0920-1186
ICR 201705-0920-004
IC 226739
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1186 can be found here:
2024-02-22 - Revision of a currently approved collection
2022-03-17 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Form 16AWE
Clinician Public Health Department Follow-Up Script - TB Treating Physicians
Form and Instruction
16AWE Attachment F CureTB Clinician_PHD Follow-up script
Attachment F CureTB Clinician_PHD Follow-up script.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Clinician Public Health Department Follow-Up Script - TB Treating Physicians
Agency IC Tracking Number:
16AWE
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
16AWE
Attachment F CureTB Clinician_PHD Follow-up script
Attachment F CureTB Clinician_PHD Follow-up script.docx
Yes
Yes
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
Epidemiologic Studies and Surveillance of Disease Problems
FR Citation:
57 FR 62812
Number of Respondents:
500
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
50 %
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
1,500
0
1,500
0
0
0
Annual IC Time Burden (Hours)
250
0
250
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.