View Information Collection (IC)

View Information Collection (IC)

IC Title:	Territories - Weekly 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.xlsx		Yes	Yes	Fillable Fileable
Other-Data elements			Att 6 - Laboratory Data.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.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	260	0	0	0	0	260
Annual IC Time Burden (Hours)	87	0	0	0	0	87
Annual IC Cost Burden (Dollars)	4,007	0	0	0	0	4,007

Documents for IC

Title	Document	Date Uploaded
No associated records found

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