Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Data Cleaning/Validation/Reformatting New 120 2280 0 Other-Data cleaning
Early Syphilis Cases (Section 2) New 406 68 0 Form and Instruction 0920-1072 Early Syphilis Cases (Section 2)
Early Syphilis Follow-up (Section 3) New 203 17 0 Form and Instruction 0920-1072 Early Syphilis Follow-up (Section 3)
Gonnorhea Case Surveillance Removed 0 0 0 Form and Instruction none Case Surveillance by Health Department Manager
Gonorrhea Patient Interview Removed 0 0 0 Form and Instruction none Patient Interview Script
Gonorrhea Patient Interview (Section 1) New 5492 915 0 Form and Instruction 0920-1072 Gonorrhea Patient Interview section 1
Record Abstraction New 60 180 0 Other-Data elements
STD Clinic-based Surveillance Removed 0 0 0 Form and Instruction none Facility Surveillance Data Elements
Total burden requested under this ICR: 6281 3460 0  
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