Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
0920-0004 Arboviral Diseases Modified 80997 6750 0 Form and Instruction none
0920-0004 Cholera and Other Vibrio Illnesses 52.79 Modified 450 150 0 Instruction
0920-0004 Diarrheal Diseases Campylobacter Modified 2756 138 0 Form 1
0920-0004 Diarrheal Diseases Salmonella Modified 2756 138 0 Instruction
0920-0004 Diarrheal Diseases Shigella Modified 2756 138 0 Instruction
0920-0004 Foodborne Outbreak 52.13 Modified 1701 567 0 Instruction
0920-0004 Influenza Annual Survey 55.31A Modified 78 20 0 Form none
0920-0004 Influenza Virus 55.31 (fax and internet Oct-May) Removed 0 0 0 Instruction
0920-0004 Influenza Virus 55.31 (fax and internet year-round) Removed 0 0 0 Instruction
0920-0004 Influenza Virus PHLIS (Oct-May) electronic Removed 0 0 0 Instruction
0920-0004 Influenza Virus PHLIS (year-round) electronic Removed 0 0 0 Instruction
0920-0004 Influenza-Like Illness (Oct-May) 55.20 Removed 0 0 0 Instruction
0920-0004 Influenza-Like Illness (year-round) 55.20E Removed 0 0 0 Instruction
0920-0004 Listeria Case Form Modified 53 27 0 Instruction
0920-0004 National Enterovirus Surveillance Report 55.9 Modified 300 75 0 Instruction
0920-0004 National Respiratory and Enteric Virus Surveillance System NREVSS 55.83A-D Modified 4680 780 0 Instruction
0920-0004 Suspected Viral Gastroenteritis (AKA Calicivirus Surveillance) Modified 100 8 0 Instruction
0920-0004 Waterborne Diseases Outbreak 52.12 Modified 57 19 0 Form CDC 52.12
Aggregate Hospitalization and Death Reporting Weekly New 2964 494 0 Form none
Babesiosis Case Report Form New 648 108 0 Form and Instruction none
Brucellosis Case Report Form New 112 37 0 Form none
CMRS Daily - City Health Officer or Vital Statistics Registrars New 13870 2774 0 Form none
CMRS Weekly - City Health Officer or Vital Statistics Registrars New 6344 1269 0 Form none
Daily Influenza-like Illness Oct - May New 46200 11550 0 Form none
Daily Influenza-like Illness year round New 76650 19163 0 Form none
Daily Novel and Pandemic Influenza Virus State Case Status Summary Update New 5700 2850 0 Form none
Enhanced Animal Rabies Surveillance Monthly Report Modified 2704 135 0 Form 55.28
HABISS Modified 120 960 0 Form No number
HABISS Monthly Reporting Form Modified 120 60 0 Form No Number
Influenza Associated Pediatric Death Case Report Form New 114 57 0 Form none
Influenza Virus Electronic year round - PHLIP New 1040 87 0 Other-Variables for electronic reporting
Influenza Virus Electronic year round PHIN-MS New 624 52 0 Other-Variables for Reporting
Influenza Virus Fax Oct-May 55.31 New 165 28 0 Form Influenza Fax
Influenza virus Internet Oct - May 55.31 New 99 17 0 Form none
Influenza virus Internet Year-Round 55.31 New 2184 364 0 Form none
Influenza virus fax year-round 55.31 New 1092 182 0 Form none
Novel Human Influenza A Virus Infection Case Report Form New 285 143 0 Form none
Novel and Pandemic Influenza A Virus Infection Case Investigation Form New 5700 2850 0 Form none
Novel and Pandemic Influenza A Virus Infection Contact Trace Back Form New 5700 2850 0 Form none
Novel and Pandemic Influenza A Virus Infection Contact Trace Forward Form New 5700 2850 0 Form none
Possible Human Rabies - Patient Information Form New 50 13 0 Form none
Rabies Monthly Report (paper) 55.28 Modified 36 9 0 Instruction
Weekly Influenza-like Illiness year round 55.20 New 106600 26650 0 Form 55.20
Weekly Influenza-like Illness Oct - May 55.20 New 17820 4455 0 Form 55.20
Total burden requested under this ICR: 399325 88817 0  
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