OMB control number

Surveillance Data Collections for Ebola Virus Disease in West Africa

OMB 0920-1085 · HHS/CDC.

OMB 0920-1085

Latest Forms, Documents, and Supporting Material

Document Name
Health Facility Assessment and Case Finding Study - Arabic Form and Instruction
Health Facility Assessment and Case Finding Study - Portuguese Form and Instruction
Health Facility Assessment and Case Finding Study - French Form and Instruction
Health Facility Assessment and Case Finding Study - English Form and Instruction
Health Care Worker EVD Exposure Risk Reporting Form - Sierra Leone Form and Instruction
Health Care Worker Ebola Virus Investigation Questionnaire - Liberia Form and Instruction
Health Care Worker EVD Exposure Risk - Arabic Form
Health Care Worker EVD Exposure Risk - Portuguese Form
Health Care Worker EVD Exposure Risk - French Form
Health Care Worker EVD Exposure Risk - English Form
Ebola Sexual Transmission Investigation Form - Arabic Form and Instruction
Ebola Sexual Transmission Investigation Form - Portuguese Form and Instruction
Ebola Sexual Transmission Investigation Form - French Form and Instruction
Ebola Sexual Transmission Investigation Form - English Form and Instruction
EVD Case Contact Questionnaire - Arabic Form and Instruction
EVD Case Contact Questionnaire - Portuguese Form and Instruction
EVD Case Contact Questionnaire - French Form and Instruction
EVD Case Contact Questionnaire - English Form and Instruction
VHF Contact Tracing Follow-Up Form - Arabic Form
VHF Contact Tracing Follow-Up Form - Portuguese Form
VHF Contact Tracing Follow-Up Form - French Form
VHF Contact Tracing Follow-Up Form - English Form
VHF Contact Listing Form - Arabic Form
VHF Contact Listing Form - Portuguese Form
VHF Contact Listing Form - French Form
VHF Contact Listing Form - English Form
VHF Case Investigation Form - Arabic Form and Instruction
VHF Case Investigation Form - Portuguese Form and Instruction
VHF Case Investigation Form - French Form and Instruction
VHF Case Investigation Form - English Form and Instruction
VHF Case Investigation (Short Form) - Arabic Form and Instruction
VHF Case Investigation (Short Form) - Portuguese Form and Instruction
VHF Case Investigation (Short Form) - French Form and Instruction
VHF Case Investigation (Short Form) - English Form and Instruction
SupStmnt A Survllnc Data Collctn EVD West Africa 20150621.docx Supporting Statement A
AppndxD West Africa Defn Burden Wage Est 20150621.docx Supplementary Document
AppndxC EVDOutbrksChronology.pdf Supplementary Document
AppndxC 2014 EVDGeoDistrbtn.pdf Supplementary Document
AppndxB 60 day FRN 20150327.pdf Supplementary Document
AppndxA Auth Legisltn 42 CFR 241.pdf Supplementary Document
SupStmnt B Survllnc Data Collctn EVD West Africa 20150621.docx Supporting Statement B
Health Facility Assessment and Case Finding Study - Arabic Form and Instruction
Health Facility Assessment and Case Finding Study - Portuguese Form and Instruction
Health Facility Assessment and Case Finding Study - French Form and Instruction
Health Facility Assessment and Case Finding Study - English Form and Instruction
Health Care Worker EVD Exposure Risk Reporting Form - Sierra Leone Form and Instruction
Health Care Worker Ebola Virus Investigation Questionnaire - Liberia Form and Instruction
Health Care Worker EVD Exposure Risk - Arabic Form
Health Care Worker EVD Exposure Risk - Portuguese Form
Health Care Worker EVD Exposure Risk - French Form
Health Care Worker EVD Exposure Risk - English Form
Ebola Sexual Transmission Investigation Form - Arabic Form and Instruction
Ebola Sexual Transmission Investigation Form - Portuguese Form and Instruction
Ebola Sexual Transmission Investigation Form - French Form and Instruction
Ebola Sexual Transmission Investigation Form - English Form and Instruction
EVD Case Contact Questionnaire - Arabic Form and Instruction
EVD Case Contact Questionnaire - Portuguese Form and Instruction
EVD Case Contact Questionnaire - French Form and Instruction
EVD Case Contact Questionnaire - English Form and Instruction
VHF Contact Tracing Follow-Up Form - Arabic Form
VHF Contact Tracing Follow-Up Form - Portuguese Form
VHF Contact Tracing Follow-Up Form - French Form
VHF Contact Tracing Follow-Up Form - English Form
VHF Contact Listing Form - Arabic Form
VHF Contact Listing Form - Portuguese Form
VHF Contact Listing Form - French Form
VHF Contact Listing Form - English Form
VHF Case Investigation Form - Arabic Form and Instruction
VHF Case Investigation Form - Portuguese Form and Instruction
VHF Case Investigation Form - French Form and Instruction
VHF Case Investigation Form - English Form and Instruction
VHF Case Investigation (Short Form) - Arabic Form and Instruction
VHF Case Investigation (Short Form) - Portuguese Form and Instruction
VHF Case Investigation (Short Form) - French Form and Instruction
VHF Case Investigation (Short Form) - English Form and Instruction

All Historical Document Collections

201505-0920-008

Approved without change

New collection (Request for a new OMB Control Number)

2015-07-13