View Information Collection (IC)

View Information Collection (IC)

IC Title:	Viral Hemorrhagic Fever Case Investigation Form (Liberia)	Agency IC Tracking Number:	0920-15CN

Is this a Common Form? No		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	0920-15CN	Attachment D_Viral Hemorrhagic Fever Case Investigation Form_Liberia (2)	Attachment D_Viral Hemorrhagic Fever Case Investigation Form_Liberia (2).pdf		No		Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: Ebola Emergency Investigation Case Records System Notice	FR Citation: 51 FR 42466

Number of Respondents: 4,000	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	4,000	0	4,000	0	0	0
Annual IC Time Burden (Hours)	1,333	0	1,333	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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