2024-22472. Agency Forms Undergoing Paperwork Reduction Act Review

Estimated Annualized Burden Hours

Type of respondents	Form name	Number of respondents	Number of responses per respondent	Average burden per response (in hours)
Residents, first responders, business owners, employees, customers	Eligibility Screener Epi CASE Survey General survey	2,500 1,000 1,000	1 1 1	2/60 17/60 60/60
Hospital staff	Hospital Survey	40	1	25/60
Staff from state, local, or tribal health agencies	Medical Chart Abstraction Form	25	10	30/60