Att E_TB Maritime Contact Investigation Worksheet

[NCEZID] Contact Investigation Outcome Reporting Forms

Documents and Forms

Document Name Document Type
Form 0920-0900 Att E_TB Maritime Contact Investigation Worksheet Form
0920-0900 TB Maritime Contact Investigation Worksheet Att. E-TB Maritime Contact Investigation Worksheet_final.xlsx Form
0920-0900 TB Maritime Contact Investigation Worksheet Att. E-TB Maritime Contact Investigation Worksheet_final.xlsx Form

Information Collection (IC) Details

IC Title:	Att E_TB Maritime Contact Investigation Worksheet	Agency IC Tracking Number:	0920-0900

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	0920-0900	TB Maritime Contact Investigation Worksheet	Att. E-TB Maritime Contact Investigation Worksheet_final.xlsx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 0920-0171 Quarantine and Traveler Related Activities, Including Records for Cpmtact Tracing Investigation and Notification under 42 CFR Parts 70 and 71	FR Citation: 72 FR 70867

Number of Respondents: 17	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	17	2	15
Annual IC Time Burden (Hours)	3	-2	5
Annual IC Cost Burden (Dollars)	0	-187	187

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.