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Survey 1 - Cruise Ship Pssengers (Group 1)
Investigation of a Cluster of Extensively Drug Resistant Shigellosis Associated with a Cruise Ship
OMB: 0920-1288
IC ID: 240758
OMB.report
HHS/CDC
OMB 0920-1288
ICR 202003-0920-004
IC 240758
( )
Documents and Forms
Document Name
Document Type
Survey 1 - Cruise Ship Pssengers (Group 1)
Form and Instruction
Appendix B - Survey Instrument 1
Appendix B. SurveyInstrument1_3.12.2020a.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Survey 1 - Cruise Ship Pssengers (Group 1)
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 and Instruction
NA
Appendix B - Survey Instrument 1
Appendix B. SurveyInstrument1_3.12.2020a.docx
NA
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
Privacy Act System of Records
Title:
09-20-0136 - Epidemiologic Studies and Surveillance of Disease Problems
FR Citation:
57 FR 62812
Number of Respondents:
4,017
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
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
4,017
0
4,017
0
0
0
Annual IC Time Burden (Hours)
670
0
670
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.