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Agenda
Reg Review
ICR
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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