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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Formative Research Legionella
Agency IC Tracking Number:
16BCR
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
Other-WORD
Attachment 1 Treating Clinician_Screener.docx
Yes
Yes
Fillable Printable
Other-WORD
Attachment 2 Infection Control Clinician_Screener.docx
Yes
Yes
Fillable Printable
Other-WORD
Attachment 3 Building Managers and Water Maintenance Staff_Screener.docx
Yes
Yes
Fillable Printable
Other-WORD
Attachment 4 Water System Risk Managment and Remediation Staff_Screener.docx
Yes
Yes
Fillable Printable
Other-WORD
Attachment 9 Treating Clinician_Interview Guide.docx
No
Paper Only
Other-WORD
Attachment 10 Infection Control Clinician_Interview Guide.docx
No
Paper Only
Other-WORD
Attachment 11 Building Managers and Water Maintenance Staff_Interview Guide.docx
No
Paper Only
Other-WORD
Attachment 12 Water System Risk Management and Remediation Staff_Interview Guide.docx
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
144
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
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
144
0
144
0
0
0
Annual IC Time Burden (Hours)
66
0
66
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Att 5_Treating Clinician Consent
Attachment 5 Treating Clinician_Consent Form.doc
08/29/2016
Att 6_ Infection Control Clinician Consent
Attachment 6 Infection Control Clinician_Consent Form.doc
08/29/2016
Att 7_Building Mgr and Water Maint. Staff Consent
Attachment 7 Building Managers and Water Maintenance Staff_Consent Form.doc
08/29/2016
Att 8_Water System Risk Mgmt & Remediation Staff Consent
Attachment 8 Water System Risk Management and Remediation Staff_Consent Form.doc
08/29/2016
Att 13_Treating Clinician_Test materials
Attachment 13 Treating Clinician_Test Materials.pdf
08/29/2016
Att 14_Infection Control Clinician_Test materials
Attachment 14 Infection Control Clinician_Test Materials.pdf
08/29/2016
Att 15_Bldg Mgrs and Water Maint. Staff_ Test materials
Attachment 15 Building Managers and Water Maintenance Staff_Test Materials.pdf
08/29/2016
Att 16_Water Risk Mgmt and Remediation Staff_Test materials
Attachment 16 Water System Risk Management and Remediation Staff_Test Materials.pdf
08/29/2016
Att 17_Email Instructions_Interview Participation
Attachment 17 Email Instructions_Interview Participation.docx
08/29/2016
Att 18_Remote Testing Procedures
Attachment 18 Remote Testing Procedures.docx
08/29/2016
Supporting Statement A
SS A 2016 Legionella_8 29 2016 final.docx
08/29/2016
Supporting Statement B
SS B 2016 Legionella_8 29 2016 final.docx
08/29/2016
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.