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
Aggregate counts of persons exposed to Highly Pathogenic Avian Influenza (HPAI New 2704 451 0 Form and Instruction n/a
Antiviral Resistant Influenza Infection Case Report Form Modified 171 86 0 Form none
Arthropod (Vector)-Borne Diseases (Non-Human Data) New 2964 2964 0 Form and Instruction n/a
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
Att G US Outpatient Influenza-like Illness Surveillance Network (ILINet) Weekly Removed 0 0 0 Form CDC 55.20
Att Z_ Waterborne Diseases Transmission Removed 0 0 0 Form CDC 52.12
Human Infection with Novel Influenza A Virus Case Report Form Modified 114 57 0 Form NA
Human Infections with Novel Influenza A Virus Severe Outcomes Modified 57 86 0 Form None
Influenza Associated Pediatric Mortality Case Report Form Modified 114 57 0 Form NA
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
National Enterovirus Surveillance Report 55.9 Modified 240 60 0 Form CDC 55.90
National Respiratory and Enteric Virus Surveillance System (NREVSS) Laboratory Assessment Modified 28600 7150 0 Form CDC 55.83A
Form CDC 55.83D
Form CDC 55.83B
Novel Influenza A Virus Case Screening Form Modified 57 14 0 Form None
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 Short Form New 208 52 0 Form and Instruction n/a
Suspect Respiratory Virus Patient Form Modified 50 25 0 Form NA
U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) Workfolder_CDC 55.20E Modified 93600 15600 0 Form CDC 55.20E
US WHO Colloborating Laboratories Influenza Testing Methods Assessment Modified 113 19 0 Form NA
Viral Gastroenteritis Outbreak Submission Form Modified 100 8 0 Form None
WHO Collaborating Center for Influenza Virus Surveillance Modified 2444 407 0 Form NA
Total burden requested under this ICR: 134983 27458 0  
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