Skip to main content
An official website of the United States government
The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.
The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.
Search:
Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
States - Reporting
Agency IC Tracking Number:
15IT
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Other-Data Elements
Attachment 4 Core Data.xlsx
Yes
Yes
Fillable Fileable
Other-Data Elements
Attachment 5 Disease-Specific Data.xlsx
Yes
Yes
Fillable Fileable
Other-XCEL
Attachment 5 Disease-Specific Data_12182014.xlsx
Yes
Yes
Printable Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Immunization Management
Privacy Act System of Records
Title:
09-20-0136 Epidemiologic Studies and Surveillance of Disease Problems
FR Citation:
57 FR 6812
Number of Respondents:
50
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
2,600
0
0
0
0
2,600
Annual IC Time Burden (Hours)
26,000
0
0
0
0
26,000
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Change Request Justification
OMB 0920-0728 change request_arboviral 12192014.doc
01/05/2015
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.