View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	2022_Monkeypox Response	Agency IC Tracking Number:	0920-1011

IC Status: New

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
Form and Instruction	0920-1011	2022 Case Report Form_MPX	MPX_CRF_final_question_list_5.31.2022e_clean.docx	NA	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Disaster Management

Subfunction: Emergency Response

Privacy Act System of Records
Title: 09-20-0136 Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 62811

Number of Respondents: 1,000	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	1,000	0	1,000	0	0	0
Annual IC Time Burden (Hours)	1,000	0	1,000	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
GenIC Request Template	1. GenIC Request Form - EEI Generic ICR_KC.docx	05/30/2022
0920-1011 MPX Response Burden Estimate	1. Burden Estimate_EEI Generic ICR.docx	05/30/2022
0920-1011 MPX CRF Cover Page	MPX CRF_Cover Page.docx	05/30/2022
CSTE Letter of Support_MPX	CSTE letter of support_Monkeypox outbreak_5_25_22v2 SOGIE.pdf	05/30/2022

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.