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Bsi_ca
Emergency Epidemic Investigation Data Collections - Expedited Reviews
OMB: 0920-1011
IC ID: 213101
OMB.report
HHS/CDC
OMB 0920-1011
ICR 201311-0920-016
IC 213101
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1011 can be found here:
2022-10-07 - Revision of a currently approved collection
2022-01-13 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
BSI_CA
Form
Chart Abstraction
Chart Abstraction Form.doc
Form
Outpatient Dialysis Practices Survey
Outpatient Dialysis Center Practices Survey.docx
Form
Reprocessing Observation Checklist
Reprocessing Observation Checklist.docx
Form
Letter of Invite.docx
Letter of Invitation
IC Document
2014017_XXX_BSI_CA.docx
Supporting Statement
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
BSI_CA
Agency IC Tracking Number:
14AYU
IC Status:
New
Obligation to Respond:
Voluntary
CFR Citation:
42 CFR USC 301 [241] (To search for a specific CFR, visit the
Code of Federal Regulations.
)
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
none
Chart Abstraction
Chart Abstraction Form.doc
No
Paper Only
Form
none
Outpatient Dialysis Practices Survey
Outpatient Dialysis Center Practices Survey.docx
No
Paper Only
Form
none
Reprocessing Observation Checklist
Reprocessing Observation Checklist.docx
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
09-20-0113 Epidemic Investigation Case Records HHS/CDC
FR Citation:
51 FR 42466
Number of Respondents:
26
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
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
26
0
26
0
0
0
Annual IC Time Burden (Hours)
85
0
85
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Letter of Invitation
Letter of Invite.docx
09/12/2014
Supporting Statement
2014017_XXX_BSI_CA.docx
09/15/2014
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.