Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
20140006XXX Measles FSM New 450 150 0 Other-WORD
Other-WORD
Other-PDF
2014004XXX_Legionnaires' Disease_Alabama 2014 New 45 11 0 Form none Record Abstraction
Form none Interview Questionnaire
2014005XXX_DiarrhealDisease_AS New 400 117 0 Form none Medical Abstraction Form
Form none Case Questionnaire
2014008-XXX Chikungunya_PR New 6256 1564 0 Form none Household Questionnaire
Form none Individual Questionnaire
Form none Case Report (English)
Form none Case Report (Spanish)
2014009-XXX_Chikungunya_US Service Org Volunteers New 294 184 0
2014010-XXX Ebola_Guinea New 2600 351 0 Form and Instruction 0920-1011 Appendix 1- Case Investigation Form
Form 0920-1011 Appendix 2- Contact Tracing Form
2014011-XXX Ebola_Liberia New 2600 350 0 Form none Case Report Form
Form none Contact Listing Form
2014012-XXX Resp Illness UC_CA New 250 83 0 Other-WORD
Other-WORD
Other-Email
2014013-XXX_Resp Illness UAC_Multi New 550 275 0 Other-WORD
Other-WORD
2014014-XXX Ebola_Sierra Leone New 3200 454 0 Other-PDF
Other-PDF
2014015-XXX_Parechovirus_Multi New 60 18 0 Form none Chart Abstraction
Form none Family interview
2014016-XXX_Ebola_DRC New 1200 134 0 Other-WORD
Other-WORD
2014E003XXX_MERS-CoV_GA New 186 40 0 Form none Questionnaire for Passengers and Crew
Form none Follow-up Questionnaire for Asymptomatic Passengers and Crew
BSI_CA New 26 85 0 Form none Chart Abstraction
Form none Outpatient Dialysis Practices Survey
Form none Reprocessing Observation Checklist
CCRF_Georgia New 830 303 0 Form none Case Investigation
Form none KAP Survey
Form none Consent
Chikungunya_USVI New 20 5 0 Other-WORD
Form and Instruction CDC 56.31 A REV. 06/2006 Dengue Case Investigation Report
Other-E-mail
Other-WORD
Ebola_TX New 76 13 0 Form None Appendix 1 - Ebola Case Investigation Form
Form and Instruction None Appendix 2 - Ebola Case Contact Questionnaire
Ebola_West Africa_2014 New 113 105 0 Form and Instruction none Observation Guide
Form and Instruction none Field Guide
Form and Instruction none Focus Group Guide
Pediatric cluster of neurologic symptoms - Colorado New 18 12 0 Form none Medical Chart Abstraction
Form none Family Interview Questionnaire
Pseudomonas NICU_CA New 235 43 0 Other-WORD
Other-WORD
Other-WORD
Other-WORD
Suicide _VA New 105 98 0 Form none Interview Guide
Form none Focus Group Guide
Total Burden Actually Used for Information Collections Under Currently Approved ICR: 19514 4395 0  
Total Burden Currently Requested for Information Collections Under Currently Approved ICR: 0 0 0  
To view an IC, click on IC Title