Gonorrhea Patient Interview (Section 1)

Enhanced STD Surveillance Network

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1072 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-1072 Gonorrhea Patient Interview (Section 1) Form and Instruction
0920-1072 Gonorrhea Patient Interview section 1 Att 8_InterviewTemplate_GC_syphilis.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Gonorrhea Patient Interview (Section 1)	Agency IC Tracking Number:	0920-1072

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	0920-1072	Gonorrhea Patient Interview section 1	Att 8_InterviewTemplate_GC_syphilis.pdf	NA	No		Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 7,380	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	7,380	1,888	5,492
Annual IC Time Burden (Hours)	1,230	315	915
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.