Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
E-cigarette associated Pulmonary Illness_Multi-State New 1520 1142 0 Form and Instruction 0920-1011 National Case Report Form - Standard
Form and Instruction 0920-1011 National Case Report Form - Abbreviated
Form 0920-1011 Specimen Manifest Form
E-cigarette associated pulmonary illness New 1000 1000 0 Form and Instruction 0920-1011 Case Interview Short Form - CDC 29AUG2019
Form and Instruction 0920-1011 Medical Chart Abstraction Short Form - CDC 29AUG2019
Multistate outbreak of coccidioidomycosis (Valley fever) in U.S. students and adults who traveled to Tijuana area, Mexico Unchanged 130 43 0 Form and Instruction 0920-1011 Questionnaire - Valley Fever
Multistate outbreak of coccidioidomycosis (Valley fever) in U.S. students and adults who traveled to Tijuana area, Mexico Unchanged 45 15 0 Form and Instruction 0920-1011 Patient Screening Questionnaire
Undetermined cause of Acute Flaccid Myelitis, multiple states, United States, 2018 Unchanged 210 210 0 Form and Instruction 0920-1011 Acute Flaccid Myelitis Case Questionnaire - English
Form and Instruction 0920-1011 Acute Flaccid Myelitis Case Questionnaire - Spanish
Undetermined risk factors for long term sequela resulting from Rocky Mountain spotted fever-Arizona, 2018 Unchanged 375 126 0 Form and Instruction 0920-1011 Patient Screening Questionnaire
Form and Instruction 0920-1011 Neurologial Examination Form
Undetermined risk factors for long term sequela resulting from Rocky Mountain spotted fever-Arizona, 2018 Unchanged 1 1 0 Form and Instruction 0920-1011 Patient Screening Questionnaire
Form and Instruction 0920-1011 Neurologic Exam Form
Total Burden Actually Used for Information Collections Under Currently Approved ICR: 3281 2537 0  
Total Burden Currently Requested for Information Collections Under Currently Approved ICR: 0 0 0  
To view an IC, click on IC Title