Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Epidemiologist - Pregnancy Module Modified 29250 14625 0 Form and Instruction NA
Form and Instruction 0920-1297
General Public - Case Investigation Form Unchanged 300 300 0 Form and Instruction NA
General Public - Household Animal Queationnaire Unchanged 60 10 0 Form and Instruction NA
General Public - Household Close-Out Form Unchanged 60 10 0 Form and Instruction NA
General Public - Household Contact Questionnaire Instrument Unchanged 200 33 0 Form and Instruction NA
General Public - Household Member Symptom Diary Unchanged 200 33 0 Form and Instruction NA
General Public - Household Questionnaire Unchanged 60 10 0 Form and Instruction NA
General Public - Risk Factor Interview Unchanged 600 300 0 Form and Instruction NA
Homeless Shelter Staff - Homeless Shelter Modified Screener Unchanged 4800 1200 0 Form and Instruction NA
Homeless Shelter Staff - Homeless Symptom Follow-Up Unchanged 700 58 0 Form and Instruction NA
Total burden requested under this ICR: 36230 16579 0  
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