Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Adenovirus Typing Report Form Modified 52 13 0 Form NA National Adenovirus Type Reporting System (NATRS) Form
Aggregate counts of persons exposed to Highly Pathogenic Avian Influenza (HPAI New 2704 451 0 Form and Instruction n/a Aggregate case counts of person exposed to Highly Pathogenic Avian Influenza (HPAI)
Antiviral Resistant Influenza Infection Case Report Form Modified 171 86 0 Form none Antiviral-Resistant Influenza Infection Case Report
Arthropod (Vector)-Borne Diseases (Non-Human Data) New 2964 2964 0 Form and Instruction n/a Arthropod (Vector)-Borne Diseases (Non-Human Data)
Att D_NORS Foodborne Disease Transmission_ Person to Person Disease Transmission_Animal Contact_Environmental Contamination_Unknown Transmission Mode Removed 0 0 0 Form CDC 52.13 NORS - Foodborne, Person-to-Person, Animal Contact, Environmental Contamination, Unknown Transmission Mode
Att G US Outpatient Influenza-like Illness Surveillance Network (ILINet) Weekly Removed 0 0 0 Form CDC 55.20 US Outpatient Influenza-like Illness Surveillance Network (ILINet) Weekly
Att Z_ Waterborne Diseases Transmission Removed 0 0 0 Form CDC 52.12 NORS - Waterborne Disease Transmission
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)
Human Infections with Novel Influenza A Virus Severe Outcomes Modified 57 86 0 Form None Human Infection with Novel Influenza A Virus Severe Outcomes
Influenza Associated Pediatric Mortality Case Report Form Modified 114 57 0 Form NA Influenza-Associated Pediatric Mortality Case Report
Influenza Virus Electronic year round - PHLIP_HL7 Messaging Data Elements Modified 2964 247 0 Other-Variables for Electronic Reporting
Influenza Virus Electronic year round PHIN-MS Modified 156 13 0 Other-Variables for Reporting
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
National Enterovirus Surveillance Report 55.9 Modified 240 60 0 Form CDC 55.90 Enterovirus Surveillance System Report Form
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
Novel Influenza A Virus Case Screening Form Modified 57 14 0 Form None Novel Influenza A Virus Case Screening Form
Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Form (CRF) New 104 78 0 Form and Instruction n/a Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Form (CRF)
Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Short Form New 208 52 0 Form and Instruction n/a Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Short Form
Suspect Respiratory Virus Patient Form Modified 50 25 0 Form NA Suspect Respiratory Virus Patient Form
U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) Workfolder_CDC 55.20E Modified 93600 15600 0 Form CDC 55.20E U.S. Outpatient Influenza-Like Illness Surveillance Network (ILINet) - Workfolder_CDC 55.20E
US WHO Colloborating Laboratories Influenza Testing Methods Assessment Modified 113 19 0 Form NA WHO Collaborating Laboratories Influenza Testing Methods Assessment
Viral Gastroenteritis Outbreak Submission Form Modified 100 8 0 Form None Viral Gastroenteritis Outbreak Submission Form
WHO Collaborating Center for Influenza Virus Surveillance Modified 2444 407 0 Form NA WHO Collaborating Center for Influenza Virus Surveillance
Total burden requested under this ICR: 134983 27458 0  
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