Att D-4_Acute Flaccid Myelitis

National Disease Surveillance Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0009 can be found here:

Documents and Forms

Document Name Document Type
Att D4_Acute Flaccid Myelitis (AFM).docx Other-WORD
0920-0009 (17AXX) Non-substantive Change 0920-0009_Acute Flaccid Myelitis AFM-patient-summary-form-update abridged 7.27.2017.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Att D-4_Acute Flaccid Myelitis	Agency IC Tracking Number:	17AXX

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-WORD			Att D4_Acute Flaccid Myelitis (AFM).docx		No		Fillable Printable
Form and Instruction	0920-0009 (17AXX)	Non-substantive Change 0920-0009_Acute Flaccid Myelitis Patient Summary Form Final 7272017	AFM-patient-summary-form-update abridged 7.27.2017.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	100	0	100
Annual IC Time Burden (Hours)	33	-17	50
Annual IC Cost Burden (Dollars)	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.