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Federal forms, ICRs, and supporting documents

Information Collection Request

Information Collection for Tuberculosis Data from Referring Entities to Cure TB

ICR 201705-0920-004 · OMB 0920-1186 · Active

Forms and Documents
DocumentTypeStatusAvailability
Form 16AWE Clinician Public Health Department Follow-Up Script - TB Treating Physicians Form and Instruction New Repair queued
Form 16AWE Cure TB Contact Source Investigation (CI/SI) Notification - Registered Nurses/Nurse Practitioners Form and Instruction New Repair queued
Form 16AWE Cure TB Transnational Notification - Tuberculosis (TB) Patients Form and Instruction New Available
Form 16AWE Cure TB Transnational Notification - Registered Nurses/Nurse Practictioners Form and Instruction New Repair queued
Attachment C IRB Determination.pdf Supplementary Document Uploaded 2017-05-08 Available
Att A3 - 42 CFR 71.pdf Supplementary Document Uploaded 2017-05-08 Available
Att A2 - 42 CFR 70.pdf Supplementary Document Uploaded 2017-05-08 Available
Att A1 - Section 361 of the Public Health Service Act (42 USC 264).pdf Supplementary Document Uploaded 2017-05-08 Available
SupSta A CureTB final .docx Supporting Statement A Uploaded 2017-05-08 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
226739 Clinician Public Health Department Follow-Up Script - TB Treating Physicians Form and Instruction New
226738 Cure TB Contact Source Investigation (CI/SI) Notification - Registered Nurses/Nurse Practitioners Form and Instruction New
226737 Cure TB Transnational Notification - Tuberculosis (TB) Patients Form and Instruction New
226736 Cure TB Transnational Notification - Registered Nurses/Nurse Practictioners Form and Instruction New
ICR Details
0920-1186 201705-0920-004
Active
HHS/CDC 16AWE
Information Collection for Tuberculosis Data from Referring Entities to Cure TB
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 06/02/2017
Retrieve Notice of Action (NOA) 05/10/2017
  Inventory as of this Action Requested Previously Approved
06/30/2020 36 Months From Approved
2,200 0 0
558 0 0
0 0 0
The objective of this information collection is to facilitate CDC coordinating of the continuity of care for individuals affected by TB who enter US jurisdictions from foreign nations who or who leave US jurisdictions bound for foreign nations.
US Code: 42 USC Code of Federal Regulations Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  81 FR 52875 08/10/2016
82 FR 1339 01/05/2017
No
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 2,200 0 0 2,200 0 0
Annual Time Burden (Hours) 558 0 0 558 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new Information Collection Request, there are no changes
$112,108
No
No
No
No
No
Uncollected
Catina Conner 404 639-4775
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
05/10/2017