2024-17764. Proposed Data Collection Submitted for Public Comment and Recommendations

Estimated Annualized Burden Hours

Type of respondents	Form name	Number of respondents	Number of responses per respondent	Average burden per response (in hours)	Total burden hours
State/Local Health department staff	Form 1 Medical Tourism Case Intake Form (Part B-Medical Chart Abstraction)	50	15	5/60	63
Ill persons who have experienced an adverse health outcome related to medical tourism	Form 1 Medical Tourism Case Intake Form (Part A-Interviews)	750	1	10/60	125
Ill persons who have experienced an adverse health outcome related to medical tourism	Form 2 Medical Tourism Enhanced Surveillance Form	500	1	30/60	250
Total					438