Burkholderia multivorans Outbreak Investigation Case Report Form

[NCEZID] EMERGENCY - B. multivorans Ice Machine Multistate Investigation

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1430 can be found here:

Documents and Forms

Document Name Document Type
Burkholderia multivorans Outbreak Investigation Case Report Form Form
Burkholderia multivorans Outbreak Investigation Case Report Form Form
Case Report Form (CRF) - B. multivorans Attachment 3 - CRF_Burkholderia_multivorans.pdf Form
Case Report Form (CRF) - B. multivorans Attachment 3 - CRF_Burkholderia_multivorans.pdf Form

Information Collection (IC) Details

IC Title:	Burkholderia multivorans Outbreak Investigation Case Report Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	N/A	Case Report Form (CRF) - B. multivorans	Attachment 3 - CRF_Burkholderia_multivorans.pdf	N/A	Yes	Yes	Fillable Fileable

Line of Business: Disaster Management

Subfunction: Emergency Response

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 40	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
Annual Number of Responses for this IC	40	40
Annual IC Time Burden (Hours)	120	120
Annual IC Cost Burden (Dollars)	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.