Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
2022_Monkeypox Response New 1000 1000 0 Form and Instruction 0920-1011 2022 Case Report Form_MPX
Pediatric Brain Abscesses, Epidural Empyemas, and Subdural Empyemas Associated with Streptococcal Species New 1200 600 0 Form and Instruction 0920-1011 CDC Pediatric Brain Abscess Case Reporting Form
Undetermined agent for hepatitis among children <10 years of age – United States, 2022 New 1200 667 0 Form and Instruction 0920-1011 Appendix 1: Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Form (CRF)
Form and Instruction 0920-1011 Appendix 2: Pediatric Hepatitis of Unknown Etiology- Exposures Questionnaire (Parental Interview)
Form and Instruction 0920-1011 Appendix 3: Domestic Hepatitis-Adenovirus Investigation Consent
Form and Instruction 0920-1011 Appendix 4: Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Form: Controls (CRF)
Form and Instruction 0920-1011 Appendix 5: Pediatric Hepatitis of Unknown Etiology- Exposures Questionnaire: Controls (Parental Interview)
Form and Instruction 0920-1011 Appendix 6: Domestic Hepatitis-Adenovirus Investigation Consent: Controls (residual blood)
Form and Instruction 0920-1011 Appendix 7: Pediatric Hepatitis of Unknown Etiology- Exposures Questionnaire (Parental Interview) - SPANISH
Form and Instruction 0920-1011 Appendix 8: Domestic Hepatitis-Adenovirus Investigation Consent - SPANISH
Undetermined agent for hepatitis among children <10 years of age – United States, 2022 New 1500 835 0 Form and Instruction 0920-1011 Pediatric Hepatitis of Unknown Etiology Case Report Form
Form and Instruction 0920-1011 Pediatric Hepatitis of Unknown Etiology Exposures Questionnaire
Form and Instruction 0920-1011 Consent Form
Undetermined risk factor for highly pathogenic avian influenza H5N1 among individuals exposed to infected birds – United States, 2022 New 7800 199 0 Form and Instruction 0920-1011 Aggregate counts of persons exposed to HPAI
Form and Instruction 0920-1011 HPAI H5 Consent Form (English)
Form and Instruction 0920-1011 HPAI H5 Consent Form (Spanish)
Form and Instruction 0920-1011 Avian Influenza Initial Case Investigation Form (English)
Form and Instruction 0920-1011 Avian Influenza Initial Case Investigation Form (Spanish)
Form and Instruction 0920-1011 Highly Pathogenic Avian Influenza A (H5N1) Exposure Questionnaire (English)
Form and Instruction 0920-1011 Highly Pathogenic Avian Influenza A (H5N1) Exposure Questionnaire (Spanish)
Form and Instruction 0920-1011 HPAI H5 Self Swab Instructions (English)
Form and Instruction 0920-1011 HPAI H5 Self Swab Instructions (Spanish)
Form and Instruction 0920-1011 Human Sera Collection Guidelines for Flu Serology
Undetermined risk factor for highly pathogenic avian influenza H5N1 among individuals exposed to infected birds – United States, 2022 New 510 85 0 Form and Instruction 0920-1011 Aggregate counts of persons exposed to highly pathogenic avian influenza (HPAI)
Undetermined risk factor for highly pathogenic avian influenza H5N1 among individuals exposed to infected birds – United States, 2022 New 450 75 0 Form and Instruction 0920-1011 Aggregate counts of persons exposed to highly pathogenic avian influenza (HPAI)
Total Burden Actually Used for Information Collections Under Currently Approved ICR: 13660 3461 0  
Total Burden Currently Requested for Information Collections Under Currently Approved ICR: 0 0 0  
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