CCRF_Georgia

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⚠️ Notice: This information collection may be referencing outdated material.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
CCRF_Georgia Form
Case Investigation Appendix 1. CCHF_Case investigation questionnaire.doc Form
KAP Survey Appendix 2. KAP Survey.docx Form
Consent Appendix 3. Consent Form.docx Form
LOI CCHF Investigation.pdf Letter of Invitation IC Document
2015001_XXX CCHF_Georgia.docx EEI Request IC Document

Information Collection (IC) Details

IC Title:	CCRF_Georgia	Agency IC Tracking Number:	15AK

IC Status: Unchanged

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	Available Electronically?	Electronic Capability
Form	none	Case Investigation	Appendix 1. CCHF_Case investigation questionnaire.doc	No	Paper Only
Form	none	KAP Survey	Appendix 2. KAP Survey.docx	No	Paper Only
Form	none	Consent	Appendix 3. Consent Form.docx	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 830	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	830	830
Annual IC Time Burden (Hours)	303	303
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Letter of Invitation	LOI CCHF Investigation.pdf	10/03/2014
EEI Request	2015001_XXX CCHF_Georgia.docx	10/03/2014

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