View Information Collection (IC)

View Information Collection (IC)

IC Title:	Neonatal Group B Streptococcal Disease Prevention Tracking 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	no number	Neonatal Group B Streptoccal Disease Prevention Tracking Form	Attachment 6_NeonatalGroupBSrtepTrackingFormFinal_Ext GBS CRF_JAN2008.pdf		Yes	Yes	Fillable Printable

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: 10	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	370	0	370	0	0	0
Annual IC Time Burden (Hours)	123	0	123	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Instructions for ABCs Neonatal Group B Streptococcal Tracking Form	Attachment 9 FINAL_instruct EXTGBS_2008.doc	08/11/2008
Cover sheet for ABCs Neonatal Tracking Form	Coversheet Neonatal Group B Strep Tracking Form7_23_08ldl.doc	08/11/2008

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