TB Indicator Reporting Form

Information Collection for Tuberculosis Data from Panel Physicians

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1102 can be found here:

Documents and Forms

Document Name Document Type
TB Indicator Reporting Form Form
TB Indicator Data Reporting Form Attachment C TB Indicator Reporting Form_2021.pdf Form
TB Indicator Data Reporting Form Attachment C TB Indicator Reporting Form_2021.pdf Form

Information Collection (IC) Details

IC Title:	TB Indicator Reporting Form	Agency IC Tracking Number:	0920-1102

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	none	TB Indicator Data Reporting Form	Attachment C TB Indicator Reporting Form_2021.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 333	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	333	-3	336
Annual IC Time Burden (Hours)	999	-9	1,008
Annual IC Cost Burden (Dollars)	105,115	656	104,459

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.