Att D-4_Acute Flaccid Myelitis

National Disease Surveillance Program

OMB: 0920-0009

IC ID: 219461

Information Collection (IC) Details

View Information Collection (IC)

Att D-4_Acute Flaccid Myelitis 17AXX
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-0009 Acute Flaccid Myelitis: Patient Summary Form D4. patient-summary-form clean copy 5.3.2022.docx NA Yes Yes Fillable Fileable

Health Public Health Monitoring

 

100 0
   
State, Local, and Tribal Governments
 
   0 %

  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 400 0 0 0 0 400
Annual IC Time Burden (Hours) 80 0 0 0 0 80
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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