Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Epidemiologist - Pregnancy Module New 20000 15000 0 Form and Instruction NA
General Public - Case Investigation Form New 300 300 0 Form and Instruction NA
General Public - Household Animal Queationnaire New 60 10 0 Form and Instruction NA
General Public - Household Close-Out Form New 60 10 0 Form and Instruction NA
General Public - Household Contact Questionnaire Instrument New 200 33 0 Form and Instruction NA
General Public - Household Member Symptom Diary New 200 33 0 Form and Instruction NA
General Public - Household Questionnaire New 60 10 0 Form and Instruction NA
General Public - Risk Factor Interview New 600 300 0 Form and Instruction NA
Homeless Shelter Staff - Homeless Shelter Modified Screener New 4800 1200 0 Form and Instruction NA
Homeless Shelter Staff - Homeless Symptom Follow-Up New 700 58 0 Form and Instruction NA
Total burden requested under this ICR: 26980 16954 0  
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