Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Att K Human Infection with Novel Influenza A Virus Case Report Form Modified 342 171 0 Form none
Form None
Att AA_ Influenza Virus Electronic year round - PHLIP_HL7 Messaging Data Elements Modified 2548 212 0 Other-Variables for Electronic Reporting
Att BB_ Influenza Virus Electronic year round PHIN-MS Modified 156 13 0 Other-Variables for Reporting
Att D_Foodborne Disease Transmission Person-to-Person_Animal Contact Modified 1728 576 0 Form and Instruction CDC 52.13
Att E_WHO Collaborating Center for Influenza Virus Surveillance Internet Year Round Modified 1820 303 0 Form CDC 55.31
Att F US WHO Colloborating Laboratories Influenza Testing Methods Assessment Modified 87 15 0 Form CDC 55.31A
Att G US Outpatient Influenza-like Illness Surveillance Network (ILINet) Weekly Modified 93600 15600 0 Form CDC 55.20
Att I_ US Outpatient Influenza-like Illiness Surveillance Network (ILINet) Daily Reports Modified 27375 4563 0 Form None
Att J_Influenza Associated Pediatric Mortality Case Report Form Modified 114 57 0 Form None
Att L Human Infection with Novel Influenza A Virus with Suspected Avian Source New 57 29 0 Form None
Att M Human Infections with Novel Influenza A Virus Severe Outcomes New 57 86 0 Form None
Att N Novel Influenza A Virus Infection Contact Tracing Form Modified 57 29 0 Form None
Att O_Novel Influenza A Virus Status Case Status Summary Modified 57 14 0 Form None
Att P Novel Influenza A Virus Case Screening Form Modified 57 14 0 Form None
Att Q_122 CMRS - City Health Officer or Vital Statistics Registrars Daily Mortality Report Modified 21170 4234 0 Form CDC 43.50
Att R_CMRS - City Health Officer or Vital Statistics Registrars Weekly Mortality Report Modified 6344 1269 0 Form none
Form CDC 43.5
Att S_Aggregate Hospitalization and Death Reporting Activity Weekly Report Form Modified 2912 485 0 Form none
Att T Antiviral Resistant Influenza Infection Case Report Form New 171 86 0 Form None
Att U_National Respiratory and Enteric Virus Surveillance System (NREVSS) Laboratory Assessment Modified 15600 3900 0 Form CDC 55.83
Form CDC 55.83A
Form CDC 55.83D
Form CDC 55.83B
Att V_ National Enterovirus Surveillance Report 55.9 Modified 300 75 0 Form CDC 55.90
Att W Adenovirus Typing Report Form New 300 75 0 Form None
Att X Middle East Respiratory Syndrome Coronavirus (MERS) Patient Under Investigation (PUI) Form New 171 71 0 Form None
Att Y_ Form for Submitting Specimens from Suspected Norovirus Outbreak Modified 100 25 0 Form None
Att Z_ Waterborne Diseases Transmission Modified 57 19 0 Form and Instruction CDC 52.12
Daily Influenza-like Illness Oct - May Removed 0 0 0 Form none
HABISS Removed 0 0 0 Form No number
HABISS Monthly Reporting Form Removed 0 0 0 Form No Number
Influenza Virus Fax Oct-May 55.31 Removed 0 0 0 Form Influenza Fax
Influenza virus Internet Oct - May 55.31 Removed 0 0 0 Form none
Influenza virus fax year-round 55.31 Removed 0 0 0 Form none
Novel and Pandemic Influenza A Virus Infection Contact Trace Back Form Removed 0 0 0 Form none
Weekly Influenza-like Illness Oct - May 55.20 Removed 0 0 0 Form 55.20
Total burden requested under this ICR: 175180 31921 0  
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