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 Arboviral Diseases
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 Diarrheal Disease Surveillance Campylobacter
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 Form and Instruction CDC 52.13 National Outbreak Reporting System
0920-0004 Influenza Annual Survey 55.31A Modified 86 22 0 Form none Influenza Annual Survey
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 and Instruction CDC 52.12 National Outbreak Reporting System: Waterborne Disease Transmission
Aggregate Hospitalization and Death Reporting Weekly Modified 2912 485 0 Form none Aggregate Hospital
Antiviral-Resistant Influenza infection Case Report Form Modified 171 86 0 Form and Instruction none Antiviral-Resistant Influenza infection Case Report Form
Babesiosis Case Report Form Modified 648 108 0 Form and Instruction none Babesiosis Case Report Form
Brucellosis Case Report Form Modified 112 37 0 Form none Brucellosis Case Report Form
CMRS Daily - City Health Officer or Vital Statistics Registrars Modified 21170 4234 0 Form none CMRS Daily
CMRS Weekly - City Health Officer or Vital Statistics Registrars Modified 6344 1269 0 Form none CMRS Weekly
Daily Influenza-like Illness Oct - May Modified 46200 11550 0 Form none Influenza-like Illness Daily and year round
Daily Influenza-like Illness year round Modified 27375 6844 0 Form none Influenza-like illness Reporting
Daily Novel and Pandemic Influenza Virus State Case Status Summary Update Modified 57 14 0 Form none Daily Case Status
Enhanced Animal Rabies Surveillance Monthly Report Modified 2704 135 0 Form 55.28 Lab confirmed cases of rabies
HABISS Modified 120 960 0 Form No number HABISS
HABISS Monthly Reporting Form Modified 120 60 0 Form No Number HABISS Report
Human Infection with Novel Influenza A Virus Case Report Form Modified 57 29 0 Form none Human Infection with Novel Influenza A Virus Case Report Form
Influenza Associated Pediatric Death Case Report Form Modified 57 29 0 Form none Pediatric Death Case Report
Influenza Virus Electronic year round - PHLIP Modified 260 22 0 Other-Variables for electronic reporting
Influenza Virus Electronic year round PHIN-MS Modified 884 74 0 Other-Variables for Reporting
Influenza Virus Fax Oct-May 55.31 Modified 165 28 0 Form Influenza Fax WHO Fax Form
Influenza virus Internet Oct - May 55.31 Modified 99 17 0 Form none WHO Electronic
Influenza virus Internet Year-Round 55.31 Modified 1820 303 0 Form none WHO Electronic Form
Influenza virus fax year-round 55.31 Modified 1092 182 0 Form none WHO Fax Form
NREVSS Laboratory Assessment New 90 30 0 Form none Lab Assessment
Novel and Pandemic Influenza A Virus Infection Case Investigation Form Modified 57 29 0 Form none Influenza A Case Investigation
Novel and Pandemic Influenza A Virus Infection Contact Trace Back Form Modified 57 29 0 Form none Influenza A Trace Back
Novel and Pandemic Influenza A Virus Infection Contact Trace Forward Form Modified 57 29 0 Form none Trace Forward
Possible Human Rabies - Patient Information Form Modified 50 13 0 Form none Possible Human Rabies
Rabies Monthly Report (paper) 55.28 Modified 36 9 0 Instruction
Weekly Influenza-like Illiness year round 55.20 Modified 65520 16380 0 Form 55.20 Weekly Influenza Like Illness
Weekly Influenza-like Illness Oct - May 55.20 Modified 17820 4455 0 Form 55.20 Weekly Influenza-like Illness
Total burden requested under this ICR: 292746 56252 0  
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