2014011-XXX Ebola_Liberia

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⚠️ Notice: This information collection may be referencing outdated material.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
2014011-XXX Ebola_Liberia Form
Case Report Form Appendix 1--CASE REPORT FORM.pdf Form
Contact Listing Form Appendix 2--CONTACT LISTING FORM.pdf Form
2014011-XXX_Ebola_Liberia Request.pdf Letter of Invitation IC Document
2014011-XXX_Ebola_Liberia.docx Request for Approval IC Document

Information Collection (IC) Details

IC Title:	2014011-XXX Ebola_Liberia	Agency IC Tracking Number:	0920-14ANY

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
Form	none	Case Report Form	Appendix 1--CASE REPORT FORM.pdf		No		Paper Only
Form	none	Contact Listing Form	Appendix 2--CONTACT LISTING FORM.pdf		No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

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

Number of Respondents: 2,600	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	2,600	2,600
Annual IC Time Burden (Hours)	350	350
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Letter of Invitation	2014011-XXX_Ebola_Liberia Request.pdf	07/08/2014
Request for Approval	2014011-XXX_Ebola_Liberia.docx	07/08/2014

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