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General Public - Case Investigation Form
SARS-CoV-2 Epidemiologic Data Collections
OMB: 0920-1297
IC ID: 241628
OMB.report
HHS/CDC
OMB 0920-1297
ICR 202009-0920-012
IC 241628
( )
Documents and Forms
Document Name
Document Type
General Public - Case Investigation Form
Form and Instruction
Case Investigation Form
3. Case Investigation Form_instrument_OMB_updated_04.23.20.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
General Public - Case Investigation Form
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
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
Case Investigation Form
3. Case Investigation Form_instrument_OMB_updated_04.23.20.docx
NA
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Disaster Management
Subfunction:
Emergency Response
Privacy Act System of Records
Title:
Epidemiologic Studies and Surveillance of Disease Problems
FR Citation:
57 FR 92812
Number of Respondents:
300
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
50 %
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
300
0
0
0
0
300
Annual IC Time Burden (Hours)
300
0
0
0
0
300
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.