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⚠️ Notice: This information collection may be referencing outdated material.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
Form 0920-0009 Att D-4_Acute Flaccid Myelitis Form and Instruction
0920-0009 AFM form D4. AFM Form final.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
Form and Instruction	0920-0009	AFM form	D4. AFM Form final.docx		No		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	400	300	100
Annual IC Time Burden (Hours)	80	30	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.