2014009-XXX_Chikungunya_US Service Org Volunteers

Emergency Epidemic Investigation Data Collections - Expedited Reviews

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1011 can be found here:

Documents and Forms

Document Name Document Type
Letter of Invite from Texas.pdf Letter of Invitation IC Document
2014009-XXX_Chikungunya_Humanitarian Volunteers.docx Request for Approval IC Document
Appendix 1-- CASE REPORT FORM.pdf Case Report Form IC Document
Appendix 2 -- BLOOD COLLECTION Consent, Assent.pdf Blood Collection Consent/Assent IC Document

Information Collection (IC) Details

IC Title:	2014009-XXX_Chikungunya_US Service Org Volunteers	Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 301 Public Health Service Act

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: Epidemic Investigation Case Records	FR Citation: 51 FR 42466

Number of Respondents: 294	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	294	294
Annual IC Time Burden (Hours)	184	184
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Letter of Invitation	Letter of Invite from Texas.pdf	07/03/2014
Request for Approval	2014009-XXX_Chikungunya_Humanitarian Volunteers.docx	07/03/2014
Case Report Form	Appendix 1-- CASE REPORT FORM.pdf	07/03/2014
Blood Collection Consent/Assent	Appendix 2 -- BLOOD COLLECTION Consent, Assent.pdf	07/03/2014

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