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 Unchanged 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
Cholera_Kenya Unchanged 550 183 0 Form and Instruction None Community Questionnaire
Form and Instruction None Healthcare Worker Questionnaire
Dengue_AZ Unchanged 220 56 0 Other-WORD
Other-WORD
Other-WORD
Form CDC56.31A DENGUE Case Investigation Report
EEI Guillain-Barre Syndrome_Bahia Brazil Unchanged 140 80 0 Form NA Case Control Questionnaire - GBS English
Form NA Case Control Questionnaire - GBS Portugese
Form NA Chart Abstraction Questionnaire - GBS English
Form NA Chart Abstraction Questionnaire - GBS Portugese
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
GAS_IL 2015 Unchanged 300 117 0 Form NA GAS_IL Medical Record Abstraction
Form and Instruction NA GAS_IL Employee Questionnaire
Mucormycosis_Kansas Unchanged 26 43 0 Form and Instruction None Infection Prevention and Control Questions for Investigation of Mucormycosis
Form and Instruction None Mucormycosis Data Abstraction Form
PA NTM Unchanged 10 12 0 Form none Interview Questions
Form none Records Abstraction Information
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
Qualitative Investigation of HIV Transmission in Southeastern Indiana, 2015 Unchanged 30 45 0 Form and Instruction NA HIV Risk Factors Interview Guide
Tainted Beverage_Mozambique Unchanged 250 83 0 Other-WORD
Other-WORD
Undetermined Mode of Transmission_Zika Virus among Utah Community Members, 2016 Unchanged 250 63 0 Form and Instruction NA Community Member Questionnaire
Undetermined Mode of Transmission_Zika Virus among Utah Health Care Providers, 2016 Unchanged 100 20 0 Form and Instruction NA Healthcare Professional Risk Assessment Questionnaire
Undetermined Source of an outbreak of Legionnaires' Disease among Hotel A Visitors - Hannibal, MO 2015 Unchanged 12 18 0 Form and Instruction NA Legionella Environmental Assessment Form
Form NA Sample Data Sheet
Undetermined agent, source, mode of transmission, and risk factors for Guillain-Barré Syndrome in the setting of Zika virus transmission - Colombia, 2016 Unchanged 180 90 0 Form and Instruction NA GBS_Columbia Case Control Investigation Questionnaire - English
Form and Instruction NA GBS_Columbia Case Control Investigation Questionnaire - Spanish
Form and Instruction NA GBS_Columbia Chart Abstraction Form - English
Form and Instruction NA GBS_Columbia Chart Abstraction Form - Spanish
Undetermined risk factors and modes of transmission for Shigella sonnei infection among residents of Genesee and Saginaw Counties – Michigan, 2016 New 300 200 0 Form and Instruction NA SHIGELLOSIS OUTBREAK CASE-CONTROL QUESTIONNAIRE - Gennessee/Saginaw Counties
Undetermined risk factors associated with increase in bites from rabid dogs, resulting in at least one human death, Gonaives, Haiti, 2015 Unchanged 180 55 0 Form and Instruction NA Community Suyrvey - English
Form and Instruction NA Community Survey - French
Form and Instruction NA Medical Providers Interview Survey - English
Form and Instruction NA Medical Providers Interview Survey - French
Form and Instruction NA Rabies Official Interview Survey - English
Form and Instruction NA Rabies Official Interview Survey - French
Form and Instruction NA Public Health Official Interview Survey - English
Form and Instruction NA Public Health Official Interview Survey - French
Undetermined risk factors for E.coli O157 among visitors to a goat dairy--Connecticut, 2016 Unchanged 100 50 0 Form and Instruction NA Festival A Interview Form
Undetermined risk factors for Exophiala dermatitidis among oncology patients - New York City, 2016. Unchanged 35 8 0 Form and Instruction NA CDC Call Script
Form and Instruction NA NYC Healthcare Worker Questionnaire
Undetermined risk factors for ocular syphilis - North Carolina, 2015 Unchanged 100 88 0 Form NA Abstraction Form
Form NA Interview Form
Undetermined risk of exposure for human-to-human spread of rabies to contact of case patient following mongoose-associated human rabies case, Puerto Rico, 2015. Unchanged 250 50 0 Form and Instruction NA Community Assessment
Form and Instruction NA Community Assessment - Spanish
Form and Instruction NA Healthcare Worker Assessment
Form and Instruction NA Healthcare Worker Assessment
Undetermined source and risk factors for botulism among prisoners at a correctional facility - Mississippi, 2016 Unchanged 40 20 0 Form and Instruction NA Questionnaire for Prison Outreak of Clostridium Botulinum, June 2016
Undetermined source for Salmonella Infantis infections among detention center inmates - South Carolina, 2016 Unchanged 300 225 0 Form and Instruction NA Salmonella Infantis Infections among Detention Center Inmates - Case Interview Form
Undetermined source of Elizabethkingia anophelis infections among Wisconsin residents - Wisconsin, 2016 Unchanged 25 50 0 Form and Instruction NA Focus Group Discussion Guide
Undetermined source of Elizabethkingia meningoseptica bloodstream infection among Wisconsin residents - Wisconsin, 2016 Unchanged 25 32 0 Form and Instruction NA Elizabethkingia Meningoseptica Case Investigation Form
Undetermined source, mode of transmission, and risk factors for Candida auris infection - Colombia, 2016 New 70 35 0 Form and Instruction NA Case Report Form - English
Form and Instruction NA Case Report Form - Spanish
Form and Instruction NA HealthCare Provider Interview
Form and Instruction NA Patient Open-Ended Interview
Undetermined source, mode of transmission, and risk factors for Hepatitis A virus (HAV) transmission ‒ Hawaii, 2016 Unchanged 600 225 0 Form and Instruction NA HEPATITIS A VIRUS (HAV) OUTBREAK HAWAII, 2016—CASE QUESTIONNAIRE
Form and Instruction NA HEPATITIS A VIRUS (HAV) OUTBREAK HAWAII, 2016—CONTROL QUESTIONNAIRE
Undetermined source, mode of transmission, and risk factors for an outbreak of group A Streptococcus among residents of a long term care facility - Chicago, Illinois, 2016 Unchanged 443 151 0 Form and Instruction NA Invasive GAS in LTCF 2016 - Employee Survey
Form and Instruction NA Investigation of GAS outbreak in LTCF 2016 - Resident Record Extraction Form
Form and Instruction NA Invasive GAS in Long Term Care Facility 2016 - Wound Care Survey
Undetermined sources and risk factors for a Rift Valley Fever Outbreak-Uganda, 2016 Unchanged 750 375 0 Form and Instruction NA Risk Factor Questionnaire
Form and Instruction NA Livestock Assessment Form
Undetermined sources, modes of transmission, risk factors, and health outcomes for Zika virus infection - Brazil, 2016 Unchanged 685 320 0 Form and Instruction NA Survey Questionnaire
Form NA Chart Abstraction
Undetermined sources, modes of transmission, risk factors, and health outcomes for Zika virus infection - Puerto Rico, 2016 Unchanged 102 77 0 Form and Instruction NA Zika Virus Disease Case Investigation Form
Form and Instruction NA 2016 Urgent Assessment of Blood Collection and Use in Puerto Rico in Response to the Zika Virus Outbreak
Undetermined sources, modes of transmission, risk factors, and health outcomes for Zika virus infection – American Samoa, 2016 Unchanged 800 134 0 Form and Instruction NA Zika Virus Disease Case Investigation Form
Undetermined transmission and risk factors for multidrug-resistant Mycobacterium tuberculosis among Tribal members - Arizona, 2016 Unchanged 140 90 0 Form and Instruction NA Case Abstraction Form
Form and Instruction NA Case Interview Form
Form and Instruction NA Contact Interview and Abstraction Form
Total Burden Actually Used for Information Collections Under Currently Approved ICR: 26732 7395 0  
Total Burden Currently Requested for Information Collections Under Currently Approved ICR: 0 0 0  
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