Household Surveillance patients Form 8a Follow Up Assessment

United States and Global Human Influenza Surveillance in at-Risk Settings (NIAID)

Documents and Forms

Document Name Document Type
Form 24 Household Surveillance patients Form 8a Follow Up Assessment Form
24 Attachment 10 Form 8a Follow Up Assessment Attachment 10 -Form8a Follow Up Assessment.pdf Form

Information Collection (IC) Details

IC Title:	Household Surveillance patients Form 8a Follow Up Assessment	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	24	Attachment 10 Form 8a Follow Up Assessment	Attachment 10 -Form8a Follow Up Assessment.pdf		No		Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,000	3,000
Annual IC Time Burden (Hours)	500	500
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.