View Information Collection (IC)
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:
Investigation of Multistate Outbreak of Severe Illness related to consumption of Diamond ShruumzTM Brand products-United States_2024
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
Diamond Shruumz Outbreak Investigation Case Report Form
Appx1 Protocol for Case Report and Investig QRE for Diamond Shruumz Outbreak Investig_Final.pdf
N/A
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Disaster Management
Subfunction:
Emergency Response
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
100
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
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
100
0
100
0
0
0
Annual IC Time Burden (Hours)
83
0
83
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
0920-1011 EEI GenIC Request Memo
1. GenIC Request Form - EEI Generic ICR_DiamondShruumz_Final.docx
07/03/2024
Burden Estimate Memo
0920-1011 - Burden Estimate Email.msg
07/03/2024
CSTE Letter of Support
CSTE Letter to Dr Erik Svendsen - NCEH.pdf
07/03/2024
Letter of Invitation - Sample_AZ
AZ Letter of Support 20240625.NCEH.pdf
07/03/2024
Letter of Invitation - Sample_NV
NV Letter of Support for coordinated investigation support NCEH Outbreak 2024-06-24.pdf
07/03/2024
CDC Memo EEI Diamond Shruumz
CDCMemo_EEI_DiamondShruumz AC 7-3-2024.pdf
07/05/2024
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.