EDN TB Follow-up Worksheet

US Tuberculosis Follow-up Worksheet for Newly Admitted Persons with Overseas Tuberculosis Classifications

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1238 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-1238 EDN TB Follow-up Worksheet Form
0920-1238 The EDN Tuberculosis Follow-Up Worksheet for Newly-Arriv Att 3 2021 EDN TB Follow-Up Worksheet.pdf Form
0920-1238 The EDN Tuberculosis Follow-Up Worksheet for Newly-Arriv Att 3 2021 EDN TB Follow-Up Worksheet.pdf Form
Att 3a_Detailed Chart of Revisions on the 2021 EDN TB Follow-Up Worksheet.docx Revisions Made to The EDN Tuberculosis Follow-Up Worksheet IC Document
Att 3a_Detailed Chart of Revisions on the 2021 EDN TB Follow-Up Worksheet.docx Revisions Made to The EDN Tuberculosis Follow-Up Worksheet IC Document

Information Collection (IC) Details

IC Title:	EDN TB Follow-up Worksheet	Agency IC Tracking Number:	0920-1238

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	0920-1238	The EDN Tuberculosis Follow-Up Worksheet for Newly-Arrived Persons with Overseas Tuberculosis Classifications	Att 3 2021 EDN TB Follow-Up Worksheet.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Alien Tuberculosis Follow-up Program	FR Citation: 51 FR 42462

Number of Respondents: 2,262	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	9,048	-17,352	26,400
Annual IC Time Burden (Hours)	4,524	-8,676	13,200
Annual IC Cost Burden (Dollars)	169,107	-324,309	493,416

Documents for IC

Title	Document	Date Uploaded
Revisions Made to The EDN Tuberculosis Follow-Up Worksheet	Att 3a_Detailed Chart of Revisions on the 2021 EDN TB Follow-Up Worksheet.docx	05/17/2022

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.