OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

US Tuberculosis Follow-up Worksheet for Newly Admitted Persons with Overseas Tuberculosis Classifications

ICR 201804-0920-016 · OMB 0920-1238 · Active

Forms and Documents
DocumentTypeStatusAvailability
EDN TB Follow-up Worksheet Form New Repair queued
Attachment 5–CDC Non-Research Determination.pdf Supplementary Document Uploaded 2018-04-26 Available
Attachment 4-EDN_PIA_2014-12-23.pdf Supplementary Document Uploaded 2018-04-26 Available
Attachment 2 60 Day Federal Register Notice.pdf Supplementary Document Uploaded 2018-04-26 Repair queued
Attachment 1C- 42 CFR Part 34.pdf Supplementary Document Uploaded 2018-04-26 Available
Attachment 1B-Public Health Service Act 42 U.S.C. 252.pdf Supplementary Document Uploaded 2018-04-26 Available
Attachment 1A-Immigration and Nationality Act 8 U.S.C. § 1182.pdf Supplementary Document Uploaded 2018-04-26 Available
Supporting Statement B-TB Follow up Worksheet_CLEAN.DOCX Supporting Statement B Uploaded 2018-04-26 Available
Supporting Statement A-TB Follow up Worksheet (002)_CLEAN.DOCX Supporting Statement A Uploaded 2018-04-26 Available
IC Document Collections
IC IDCollectionTypeStatusForm
231229 EDN TB Follow-up Worksheet Form New
ICR Details
0920-1238 201804-0920-016
Active
HHS/CDC 0920-18KG
US Tuberculosis Follow-up Worksheet for Newly Admitted Persons with Overseas Tuberculosis Classifications
Existing collection in use without an OMB Control Number   No
Regular
Approved without change 06/15/2018
Retrieve Notice of Action (NOA) 05/14/2018
  Inventory as of this Action Requested Previously Approved
06/30/2021 36 Months From Approved
26,400 0 0
13,200 0 0
493,416 0 0
The purpose of this data collection is to follow-up with and assess newly arrived persons in the US who received overseas TB classifications in order to assist in the national effort to prevent new transmission of TB.
US Code: 8 USC 1182 Name of Law: Immigration and Nationality Act
   US Code: 42 USC 252 Name of Law: PHSA
  
None
Not associated with rulemaking
  83 FR 4484 01/31/2018
83 FR 22072 05/11/2018
Yes
1
IC Title Form No. Form Name
EDN TB Follow-up Worksheet none EDN TB Follow-up Worksheet
  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 26,400 0 0 0 0 26,400
Annual Time Burden (Hours) 13,200 0 0 0 0 13,200
Annual Cost Burden (Dollars) 493,416 0 0 0 0 493,416
No
No
$139,500
No
    Yes
    Yes
No
No
No
Uncollected
Shari Steinberg 404 639-4942 [email protected]
  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.
05/14/2018