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Triazole-resistant Aspergillus fumigatus Case Report Form
[NCEZID] Characteristics of Cases of Priority Fungal Diseases
OMB: 0920-1385
IC ID: 254011
OMB.report
HHS/CDC
OMB 0920-1385
ICR 202402-0920-008
IC 254011
( )
Documents and Forms
Document Name
Document Type
Triazole-resistant Aspergillus fumigatus Case Report Form
Form and Instruction
Triazole-resistant Aspergillus fumigatus Case Report For
Att 3a- Triazole-resistant Aspergillus fumigatus Case Report Form.docx
Form and Instruction
Triazole-resistant Aspergillus fumigatus Case Report For
Att 3a- Triazole-resistant Aspergillus fumigatus Case Report Form.docx
Form and Instruction
Triazole-resistant Aspergillus fumigatus Case Report For
Att 3a- Triazole-resistant Aspergillus fumigatus Case Report Form.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Triazole-resistant Aspergillus fumigatus Case Report Form
Agency IC Tracking Number:
0920-1385
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
n/a
Triazole-resistant Aspergillus fumigatus Case Report Form
Att 3a- Triazole-resistant Aspergillus fumigatus Case Report Form.docx
Yes
Yes
Fillable Fileable
Form and Instruction
n/a
Triazole-resistant Aspergillus fumigatus Case Report Form rev
Att 3a- Triazole-resistant Aspergillus fumigatus Case Report Form.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
15
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 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
225
0
210
0
0
15
Annual IC Time Burden (Hours)
113
0
105
0
0
8
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.