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 114 57 0 Form NA Human Infection with Novel Influenza A Virus Case Report Form (addition of Suspected Avian Source)
Att AA_ Influenza Virus Electronic year round - PHLIP_HL7 Messaging Data Elements Modified 2964 247 0 Other-Variables for Electronic Reporting
Att BB_ Influenza Virus Electronic year round PHIN-MS Unchanged 156 13 0 Other-Variables for Reporting
Att D_NORS Foodborne Disease Transmission_ Person to Person Disease Transmission_Animal Contact_Environmental Contamination_Unknown Transmission Mode Modified 1998 666 0 Form CDC 52.13 NORS - Foodborne, Person-to-Person, Animal Contact, Environmental Contamination, Unknown Transmission Mode
Att E_WHO Collaborating Center for Influenza Virus Surveillance Modified 2756 459 0 Form NA WHO Collaborating Center for Influenza Virus Surveillance
Att F US WHO Colloborating Laboratories Influenza Testing Methods Assessment Modified 113 19 0 Form NA WHO Collaborating Laboratories Influenza Testing Methods Assessment
Att G US Outpatient Influenza-like Illness Surveillance Network (ILINet) Weekly Modified 93600 15600 0 Form CDC 55.20 US Outpatient Influenza-like Illness Surveillance Network (ILINet) Weekly
Att I_ US Outpatient Influenza-like Illiness Surveillance Network (ILINet) Daily Reports Removed 0 0 0 Form None US Outpatient Influenza like Illness Surveillance Network (ILINet) Daily Reports
Att J_Influenza Associated Pediatric Mortality Case Report Form Modified 114 57 0 Form NA Influenza-Associated Pediatric Mortality Case Report
Att L Human Infection with Novel Influenza A Virus with Suspected Avian Source Removed 0 0 0 Form None Human Infection with Novel Influenza A Virus with Suspected Avian Source
Att M Human Infections with Novel Influenza A Virus Severe Outcomes Unchanged 57 86 0 Form None Human Infection with Novel Influenza A Virus Severe Outcomes
Att N Novel Influenza A Virus Infection Contact Tracing Form Removed 0 0 0 Form None Novel Influenza A Virus Infection Contact Tracing Form
Att O_Novel Influenza A Virus Status Case Status Summary Removed 0 0 0 Form None Novel Influenza A Virus Case Status Summary
Att P Novel Influenza A Virus Case Screening Form Modified 57 14 0 Form None Novel Influenza A Virus Case Screening Form
Att Q_122 CMRS - City Health Officer or Vital Statistics Registrars Daily Mortality Report Removed 0 0 0 Form CDC 43.50 122 CMRS -City Health Officers or Vital Statistics Registrars Daily Mortality Report
Att R_CMRS - City Health Officer or Vital Statistics Registrars Weekly Mortality Report Removed 0 0 0 Form none CMRS Weekly
Form CDC 43.5 122 CMRS-City Health Officers or Vital Statistics Registrars Weekly Mortality Report
Att S_Aggregate Hospitalization and Death Reporting Activity Weekly Report Form Removed 0 0 0 Form none Aggregate Hospital
Att T Antiviral Resistant Influenza Infection Case Report Form Unchanged 171 86 0 Form none Antiviral-Resistant Influenza Infection Case Report
Att U_National Respiratory and Enteric Virus Surveillance System (NREVSS) Laboratory Assessment Modified 28600 7150 0 Form CDC 55.83A NREVSS Antigen Detection Worksheet
Form CDC 55.83D NREVSS Polymerase Chain Reaction (PCR) Worksheet
Form CDC 55.83B NREVSS Virus Isolation (culture) Worksheet
Att V_ National Enterovirus Surveillance Report 55.9 Modified 240 60 0 Form CDC 55.90 Enterovirus Surveillance System Report Form
Att W Adenovirus Typing Report Form Modified 52 13 0 Form NA National Adenovirus Type Reporting System (NATRS) Form
Att X Middle East Respiratory Syndrome Coronavirus (MERS) Patient Under Investigation (PUI) Form Modified 171 71 0 Form None Middle East Respiratory Syndrome (MERS) Patient Under Investigation (PUI) Short Form
Att Y_ Viral Gastroenteritis Outbreak Submission Form Modified 100 8 0 Form None Viral Gastroenteritis Outbreak Submission Form
Att Z_ Waterborne Diseases Transmission Modified 59 20 0 Form CDC 52.12 NORS - Waterborne Disease Transmission
Att. CC Suspect Respiratory Virus Patient Form New 50 25 0 Form NA Suspect Respiratory Virus Patient Form
Att. H U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) Workfolder_CDC 55.20E New 1800 150 0 Form CDC 55.20E U.S. Outpatient Influenza-Like Illness Surveillance Network (ILINet) - Workfolder_CDC 55.20E
Total burden requested under this ICR: 133172 24801 0  
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