View Information Collection (IC)

View Information Collection (IC)

IC Title:	Cluster Follow-up Report	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	n/a	Cluster Follow-up Form	Att_6_ Updated revised Cluster Report Form for OMB 08132021 changes accepted_followup.pdf		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Epidemiologic Studies and Surveillance of Disease Problems HHS/CDC	FR Citation: 57 FR 62812

Number of Respondents: 59	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 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	295	0	0	0	0	295
Annual IC Time Burden (Hours)	148	0	0	0	0	148
Annual IC Cost Burden (Dollars)	3,983	0	0	0	0	3,983

Documents for IC

Title	Document	Date Uploaded
Instructions: Cluster Investigation Reporting	Att 4f_Cluster Investigation Report Form Instructions 9.10.1.pdf	06/26/2019

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.