Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
20140006XXX Measles FSM Unchanged 450 150 0 Other-WORD
Other-WORD
Other-PDF
2014004XXX_Legionnaires' Disease_Alabama 2014 Unchanged 45 11 0 Form none Record Abstraction
Form none Interview Questionnaire
2014005XXX_DiarrhealDisease_AS Unchanged 400 117 0 Form none Medical Abstraction Form
Form none Case Questionnaire
2014008-XXX Chikungunya_PR Unchanged 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 Unchanged 294 184 0
2014010-XXX Ebola_Guinea Unchanged 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 Unchanged 2600 350 0 Form none Case Report Form
Form none Contact Listing Form
2014012-XXX Resp Illness UC_CA Unchanged 250 83 0 Other-WORD
Other-WORD
Other-Email
2014013-XXX_Resp Illness UAC_Multi Unchanged 550 275 0 Other-WORD
Other-WORD
2014014-XXX Ebola_Sierra Leone Unchanged 3200 454 0 Other-PDF
Other-PDF
2014015-XXX_Parechovirus_Multi Unchanged 60 18 0 Form none Chart Abstraction
Form none Family interview
2014016-XXX_Ebola_DRC Unchanged 1200 134 0 Other-WORD
Other-WORD
2014E003XXX_MERS-CoV_GA Unchanged 186 40 0 Form none Questionnaire for Passengers and Crew
Form none Follow-up Questionnaire for Asymptomatic Passengers and Crew
BSI_CA Unchanged 26 85 0 Form none Chart Abstraction
Form none Outpatient Dialysis Practices Survey
Form none Reprocessing Observation Checklist
Burkholderia Investigation_LA New 310 103 0 Form and Instruction None Risk Assessment for Primate Research Center Employees and Inspectors
CCRF_Georgia Unchanged 830 303 0 Form none Case Investigation
Form none KAP Survey
Form none Consent
Chikungunya_USVI Unchanged 20 5 0 Other-WORD
Form and Instruction CDC 56.31 A REV. 06/2006 Dengue Case Investigation Report
Other-E-mail
Other-WORD
Dengue_AZ New 220 56 0 Other-WORD
Other-WORD
Other-WORD
Form CDC56.31A DENGUE Case Investigation Report
Ebola_TX Unchanged 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 Unchanged 113 105 0 Form and Instruction none Observation Guide
Form and Instruction none Field Guide
Form and Instruction none Focus Group Guide
Mucormycosis_Kansas New 26 43 0 Form and Instruction None Infection Prevention and Control Questions for Investigation of Mucormycosis
Form and Instruction None Mucormycosis Data Abstraction Form
Pediatric cluster of neurologic symptoms - Colorado Unchanged 18 12 0 Form none Medical Chart Abstraction
Form none Family Interview Questionnaire
Pseudomonas NICU_CA Unchanged 235 43 0 Other-WORD
Other-WORD
Other-WORD
Other-WORD
Tainted Beverage_Mozambique New 250 83 0 Other-WORD
Other-WORD
Total Burden Actually Used for Information Collections Under Currently Approved ICR: 20215 4582 0  
Total Burden Currently Requested for Information Collections Under Currently Approved ICR: 0 0 0  
To view an IC, click on IC Title