[NCEZID] Information Collection for Tuberculosis Data from Referring Entities to CureTB

ICR 202402-0920-003

OMB: 0920-1186

Federal Form Document

Forms and Documents

Document Name	Status
Form 0920-1186 CureTB Partner Feedback (Satsifaction Assessment) Questionnaire 2 Form and Instruction	Modified
Form 0920-1186 CureTB Partner Feedback (Satisfaction Assessment) Questionnaire 1 Form and Instruction	Modified
Form CS347315-A (02/01/ CureTB Transnational Notification (TB patients referred by ICE) Form and Instruction	Modified
Form 0920-1186 Telephone Script Clinician /Foreign Health Authority Follow-up (CureTB) Form and Instruction	Modified
Form CS347315-B (Revise CureTB Contact/Source Investigation (CI/SI) Notification (USHD - local & state) Form and Instruction	Modified
Form CS347315-A (02/01/ CureTB Transnational Notification (TB patients referred by USHD) Form and Instruction	Modified
Form CS347315-A (02/01/ Cure TB Transnational Notification (referral from LHDs) Form and Instruction	Modified
Att. J-CureTB Notification Email.pdf Supplementary Document	2024-02-21
Determination email to PIA (0920-1186).pdf Supplementary Document	2024-02-09
Att. I- CureTB-PIA-Signed.pdf Supplementary Document	2024-02-21
SSA_CureTB_022124_v2.docx Supporting Statement A	2024-02-21
Att. H- Human Subjects Determination.pdf Supplementary Document	2024-02-21
Att. B- Published 60-Day Federal Register Notice.pdf Supplementary Document	2024-02-09
Att. A5 - Section 311.pdf Supplementary Document	2020-06-08
Att. A4 - Section 301.pdf Supplementary Document	2020-06-08
Att. A3 - 42 CFR Part 71.pdf Supplementary Document	2020-06-08
Att. A2 - 42 CFR Part 70.pdf Supplementary Document	2020-06-08
Att. A1 - Section 361 of the Public Health Service Act (42 USC 264).pdf Supplementary Document	2020-06-08
Supporting Statement B_CureTB.docx Supporting Statement B	2024-02-21

IC Document Collections

IC ID	Document Title	Status
252225	CureTB Partner Feedback (Satsifaction Assessment) Questionnaire 2 Form and Instruction	Modified
252223	CureTB Partner Feedback (Satisfaction Assessment) Questionnaire 1 Form and Instruction	Modified
242057	CureTB Transnational Notification (TB patients referred by ICE) Form and Instruction	Modified
226739	Telephone Script Clinician /Foreign Health Authority Follow-up (CureTB) Form and Instruction	Modified
226738	CureTB Contact/Source Investigation (CI/SI) Notification (USHD - local & state) Form and Instruction	Modified
226737	CureTB Transnational Notification (TB patients referred by USHD) Form and Instruction	Modified
226736	Cure TB Transnational Notification (referral from LHDs) Form and Instruction	Modified