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Ebola_TX
Emergency Epidemic Investigation Data Collections - Expedited Reviews
OMB: 0920-1011
IC ID: 213323
OMB.report
HHS/CDC
OMB 0920-1011
ICR 201511-0920-002
IC 213323
( )
⚠️ Notice: This information collection may be referencing outdated material.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
Ebola_TX
Form
Appendix 1 - Ebola Case Investigation Form
Appendix 1. Ebola_Case Investigation Form.pdf
Form
Appendix 2 - Ebola Case Contact Questionnaire
Appendix 2. Ebola_Case Contact Questionnaire.pdf
Form and Instruction
LOI.pdf Letter of Invitation - TDSHS
IC Document
2014020-XXX_Ebola_Texas[1].docx
Request Letter
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Ebola_TX
Agency IC Tracking Number:
15AA
IC Status:
Unchanged
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
None
Appendix 1 - Ebola Case Investigation Form
Appendix 1. Ebola_Case Investigation Form.pdf
None
No
Paper Only
Form and Instruction
None
Appendix 2 - Ebola Case Contact Questionnaire
Appendix 2. Ebola_Case Contact Questionnaire.pdf
None
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
76
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Requested
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
76
0
0
0
0
76
Annual IC Time Burden (Hours)
13
0
0
0
0
13
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Letter of Invitation - TDSHS
LOI.pdf
10/01/2014
Request Letter
2014020-XXX_Ebola_Texas[1].docx
10/02/2014
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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