Information Collection

Contact Investigation Form: Non-TB Illness

IC 229904 under ICR 202003-0970-007 · OMB 0970-0509.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0509 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Contact Investigation Form: Non-TB Illness Form and Instruction
1 Contact Investigation Form Contact Investigation Form_Non-TB Illness.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Contact Investigation Form: Non-TB Illness	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Contact Investigation Form	Contact Investigation Form_Non-TB Illness.docx		Yes	Yes	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 120	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	480	480
Annual IC Time Burden (Hours)	77	77
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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