View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	EDN TB Follow-up Worksheet	Agency IC Tracking Number:	0920-1238

Is this a Common Form? No		IC Status: Modified

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	0920-1238	The EDN Tuberculosis Follow-Up Worksheet for Newly-Arrived Persons with Overseas Tuberculosis Classifications	Att 3 2021 EDN TB Follow-Up Worksheet.pdf		Yes	Yes	Fillable Fileable
Form	0920-1238	EDN Tuberculosis Follow-Up Worksheet for Newly-Arrived Persons with Overseas Tuberculosis Classifications - 12 OCT2023	2023 EDN TB Follow-Up Worksheet_Revised_Clean.docx	N/A	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Alien Tuberculosis Follow-up Program	FR Citation: 51 FR 42462

Number of Respondents: 2,262	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	9,048	0	0	0	0	9,048
Annual IC Time Burden (Hours)	4,524	0	0	0	0	4,524
Annual IC Cost Burden (Dollars)	169,107	0	0	0	0	169,107

Documents for IC

Title	Document	Date Uploaded
Revisions Made to The EDN Tuberculosis Follow-Up Worksheet	Att 3a_Detailed Chart of Revisions on the 2021 EDN TB Follow-Up Worksheet.docx	05/17/2022

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