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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Undetermined risk factors associated with increase in bites from rabid dogs, resulting in at least one human death, Gonaives, Haiti, 2015
Agency IC Tracking Number:
0920-1011
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 and Instruction
NA
Community Suyrvey - English
Appendix 1a - Community Survey - English.doc
NA
No
Paper Only
Form and Instruction
NA
Community Survey - French
Appendix 1b - Community Survey - French.doc
NA
No
Paper Only
Form and Instruction
NA
Medical Providers Interview Survey - English
Appendix 2a - Medical Providers Interview Survey - English edit .doc
NA
No
Paper Only
Form and Instruction
NA
Medical Providers Interview Survey - French
Appendix 2b - Medical Providers Interview Survey - French edits-.doc
NA
No
Paper Only
Form and Instruction
NA
Rabies Official Interview Survey - English
Appendix 3a - Rabies Official Interview Survey - English edits.doc
NA
No
Paper Only
Form and Instruction
NA
Rabies Official Interview Survey - French
Appendix 3b - Rabies Official Interview Survey - French -.doc
NA
No
Paper Only
Form and Instruction
NA
Public Health Official Interview Survey - English
Appendix 4a - Public Health Official Interview Survey - English.doc
NA
No
Paper Only
Form and Instruction
NA
Public Health Official Interview Survey - French
Appendix 4b - Public Health Official Interview Survey - French - edit.doc
NA
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
Privacy Act System of Records
Title:
09-20-0113 Epidemic Investigation Case Records Systems Notice
FR Citation:
51 FR 42466
Number of Respondents:
180
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
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
180
0
180
0
0
0
Annual IC Time Burden (Hours)
55
0
55
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Letter of Invitation
LOI_Haiti.pdf
11/01/2015
GenIC Request Rabies_Haiti
2016XXX-XXX Rabies_Haiti.docx
11/01/2015
Burden Hour Request - email
0920-1011 GenIC Request 2016002-XXX Rabies_Haiti.msg
11/01/2015
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.