Information Collection

Dengue_AZ

IC 214244 under ICR 201507-0920-005 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Appendix 1 Household Questionnaire.doc Other-WORD
Appendix 2 Individual Questionnaire.doc Other-WORD
Appendix 3 Environmental Collection.docx Other-WORD
CDC56.31A DENGUE Case Investigation Report Appendix 4 Dengue Case Investigation Form.pdf Form
DengueLOI.pdf Letter of Invite IC Document
2015XXX-XXX Dengue_AZ.docx Request for Approval IC Document
Dengue_AZ_Burden.docx Dengue_AZ_Burden IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Dengue_AZ	Agency IC Tracking Number:	15HI

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Other-WORD			Appendix 1 Household Questionnaire.doc	No	Fillable Printable
Other-WORD			Appendix 2 Individual Questionnaire.doc	No	Fillable Printable
Other-WORD			Appendix 3 Environmental Collection.docx	No	Fillable Printable
Form	CDC56.31A	DENGUE Case Investigation Report	Appendix 4 Dengue Case Investigation Form.pdf	No	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 220	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	220	220
Annual IC Time Burden (Hours)	56	56
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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