Information Collection

Ebola_TX

IC 213323 under ICR 201410-0920-003 · OMB 0920-1011.

⚠️ Notice: This information collection may be referencing outdated material.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
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

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	Previously Approved
Annual Number of Responses for this IC	76	76
Annual IC Time Burden (Hours)	13	13
Annual IC Cost Burden (Dollars)	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.