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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Territories - Weekly, quarterly - non-automated
Agency IC Tracking Number:
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
Att 5 - Core Data_CR_06072021.xlsx
Yes
Yes
Fillable Fileable
Other-Data elements
Att 6 - Laboratory Data_CR_06072021.xlsx
Yes
Yes
Fillable Fileable
Other-Data elements
Att 8 - Vaccine Data.xlsx
Yes
Yes
Fillable Fileable
Other-Data elements
Att 9 - VPD Data.xlsx
Yes
Yes
Fillable Fileable
Other-Data elements
Att 11 - Disease-Specific Data_CR_07022021.xlsx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
Epidemiologic Studies and Surveillance of Disease Problems
FR Citation:
76 FR 4458
Number of Respondents:
5
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
280
0
0
0
0
280
Annual IC Time Burden (Hours)
93
0
0
0
0
93
Annual IC Cost Burden (Dollars)
3,514
0
0
0
0
3,514
Documents for IC
Title
Document
Date Uploaded
Attachment 4 Core Data
Attachment 4 Core Data.xlsx
11/13/2013
Attachment 5 Disease-Specific Data
Attachment 5 Disease-Specific Data.xlsx
11/13/2013
Att 4 - Core Data.xlsx
09/21/2015
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.