Cure TB Contact Source Investigation (CI/SI) Notification - LHD

Information Collection for Tuberculosis Data from Referring Entities to CureTB

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1186 can be found here:

Documents and Forms

Document Name Document Type
Cure TB Contact Source Investigation (CI/SI) Notification - LHD Form and Instruction
CureTB Contact/Source Investigation (CI/SI) Notification Att. D -CureTB Contact Source Investigation.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Cure TB Contact Source Investigation (CI/SI) Notification - LHD	Agency IC Tracking Number:	16AWE

Is this a Common Form? No		IC Status: Modified

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	n/a	CureTB Contact/Source Investigation (CI/SI) Notification	Att. D -CureTB Contact Source Investigation.pdf		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0171, Quarantine- and Traveler-related Activities Including Records for Contact Tracing Investigation and Notification under 42 CFR Parts 70 and 71	FR Citation: 72 FR 70867

Number of Respondents: 20	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 50 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	100	0	100
Annual IC Time Burden (Hours)	50	0	50
Annual IC Cost Burden (Dollars)	2,230	2,230	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.