Form Approved
OMB No. 0923-XXXX
Exp. Date xx/xx/20xx
Line Listing (Record Keeping)
Each medical provider reporting source should keep a line listing of individuals diagnosed with or thought to have ALS along with information on whether or not the case was reported and if not, the reason. Contract surveillance staff will be in frequent contact with physician’s offices and will be available to assist with this activity.
Public reporting burden of this collection of information is estimated to average 1 hour including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed and completing and reviewing the data collection of information. An agency may not conduct or sponsor and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, GA 30333; ATTN: PRA (0923-XXXX).
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | wek1 |
| File Modified | 0000-00-00 |
| File Created | 2021-01-30 |