OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Att 4_Case Report

IC 244889 under ICR 202012-0920-005 · OMB 0920-1326.

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Att 4_Case Report 0920-20OT
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 0920 Mycoplasma genitalium Treatment Failure Registry Case Report Form Att 4 Case Report Form_MG.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

 

100 0
   
Private Sector Businesses or other for-profits
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 100 0 100 0 0 0
Annual IC Time Burden (Hours) 100 0 100 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Att 2_MgenRegistry Protocol Att 2_MgenRegistryProtocol.docx 12/11/2020
Att 3_Recruitment Email_Postedits Att 3_Recruitment email_Postedits.docx 12/11/2020
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.