View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

2019-nCoV Investigation, United States, 2020 0920-1011
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-1011 2019 nCoV Case Report Form Appendix 1 2019-nCoV Case Report Form (revised) (002).docx NA No   Paper Only
Form and Instruction 0920-1011 2019 nCoV PUI Form Appendix 2 2019-nCoV PUI Form (revised).docx NA No   Paper Only
Form and Instruction 0920-1011 2019 nCoV Household Close Contact Investigation Appendix 3 2019-nCoV nCoV Household-Close Contact Investigation Form (revised).docx NA No   Paper Only
Form and Instruction 0920-1011 Severe Pulmonary Disease Associatd with E-Cigarette Use Outbreak (Case Interview Short Form (CDC)) Appendix 2. Data Collection Forms.pdf Yes Yes Fillable Fileable

Health Illness Prevention

Epidemic Investigation Case Records - SORN number 09-20-0113  51 FR 42466

3,966 0
   
State, Local, and Tribal Governments
 
   0 %

  Requested 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 3,966 0 0 0 0 3,966
Annual IC Time Burden (Hours) 3,926 0 0 0 0 3,926
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
EpiAid Letter of Support 2019 nCoV EpiAid_LetterOfSupport_NoCoVResponseOMBInitial_01222020.pdf 01/24/2020
GenIC Request EEI 2020002-XXX nCoV_multi.docx 01/24/2020
Burden Memo Email Burden Memo Email 2019 nCoV.msg 01/24/2020
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.