View Information Collection Request (ICR) Package
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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0920-0004
ICR Reference No:
201108-0920-011
Status:
Historical Active
Previous ICR Reference No:
201005-0920-006
Agency/Subagency:
HHS/CDC
Agency Tracking No:
Title:
National Disease Surveillance Program - II. Disease Summaries
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
08/31/2011
Retrieve Notice of Action (NOA)
Date Received in OIRA:
08/29/2011
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
08/31/2014
36 Months From Approved
06/30/2013
Responses
292,485
0
154,295
Time Burden (Hours)
56,136
0
22,356
Cost Burden (Dollars)
0
0
0
Abstract:
Data on disease and preventable conditions are collected in accordance with jointly approved plans by the Center for Disease Control and Prevention and the Council of State and Territorial Health Epidemiologists. This revision request entails new disease forms being added and edits to existing forms.
Authorizing Statute(s):
US Code:
42 USC 241
Name of Law: Public Health Service Act
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
75 FR 48346
08/10/2010
30-day Notice:
Federal Register Citation:
Citation Date:
75 FR 65488
10/25/2010
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
38
IC Title
Form No.
Form Name
0920-0004 Arboviral Diseases
none
Arboviral Diseases
0920-0004 Cholera and Other Vibrio Illnesses 52.79
0920-0004 Diarrheal Diseases Campylobacter
1
Diarrheal Disease Surveillance Campylobacter
0920-0004 Diarrheal Diseases Salmonella
0920-0004 Diarrheal Diseases Shigella
0920-0004 Foodborne Outbreak 52.13
0920-0004 Influenza Annual Survey 55.31A
none
Influenza Annual Survey
0920-0004 Influenza Virus 55.31 (fax and internet Oct-May)
0920-0004 Influenza Virus 55.31 (fax and internet year-round)
0920-0004 Influenza Virus PHLIS (Oct-May) electronic
0920-0004 Influenza Virus PHLIS (year-round) electronic
0920-0004 Influenza-Like Illness (Oct-May) 55.20
0920-0004 Influenza-Like Illness (year-round) 55.20E
0920-0004 Listeria Case Form
0920-0004 National Enterovirus Surveillance Report 55.9
0920-0004 National Respiratory and Enteric Virus Surveillance System NREVSS 55.83A-D
0920-0004 Suspected Viral Gastroenteritis (AKA Calicivirus Surveillance)
0920-0004 Waterborne Diseases Outbreak 52.12
CDC 52.12
Waterborne Disease Outbreak Report
Aggregate Hospitalization and Death Reporting Weekly
none
Aggregate Hospital
Babesiosis Case Report Form
none
Babesiosis Case Report Form
Brucellosis Case Report Form
none
Brucellosis Case Report Form
CMRS Daily - City Health Officer or Vital Statistics Registrars
none
CMRS Daily
CMRS Weekly - City Health Officer or Vital Statistics Registrars
none
CMRS Weekly
Daily Influenza-like Illness Oct - May
none
Influenza-like Illness Daily and year round
Daily Influenza-like Illness year round
none
Influenza-like illness Reporting
Daily Novel and Pandemic Influenza Virus State Case Status Summary Update
none
Daily Case Status
Enhanced Animal Rabies Surveillance Monthly Report
55.28
Lab confirmed cases of rabies
HABISS
No number
HABISS
HABISS Monthly Reporting Form
No Number
HABISS Report
Influenza Associated Pediatric Death Case Report Form
none
Pediatric Death Case Report
Influenza Virus Electronic year round - PHLIP
Influenza Virus Electronic year round PHIN-MS
Influenza Virus Fax Oct-May 55.31
Influenza Fax
WHO Fax Form
Influenza virus Internet Oct - May 55.31
none
WHO Electronic
Influenza virus Internet Year-Round 55.31
none
WHO Electronic Form
Influenza virus fax year-round 55.31
none
WHO Fax Form
Novel Human Influenza A Virus Infection Case Report Form
none
Novel Human Influenza A Case
Novel and Pandemic Influenza A Virus Infection Case Investigation Form
none
Influenza A Case Investigation
Novel and Pandemic Influenza A Virus Infection Contact Trace Back Form
none
Influenza A Trace Back
Novel and Pandemic Influenza A Virus Infection Contact Trace Forward Form
none
Trace Forward
Possible Human Rabies - Patient Information Form
none
Possible Human Rabies
Rabies Monthly Report (paper) 55.28
Weekly Influenza-like Illiness year round 55.20
55.20
Weekly Influenza Like Illness
Weekly Influenza-like Illness Oct - May 55.20
55.20
Weekly Influenza-like Illness
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
292,485
154,295
0
138,190
0
0
Annual Time Burden (Hours)
56,136
22,356
0
33,780
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
Yes
Burden Increase Due to:
Miscellaneous Actions
Burden decreases because of Program Change due to Agency Discretion:
Yes
Burden Reduction Due to:
Miscellaneous Actions
Short Statement:
New forms have been added for influenza surveillance to better address the continuing emergence of new strains of influenza, such as 2009 influenza A (H1N1) virus and two new surveillance activities were added to address brucellosis and babesiosis.
Annual Cost to Federal Government:
$40,000
Does this IC contain surveys, censuses, or employ statistical methods?
Yes
Part B of Supporting Statement
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
No
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Daniel Holcomb 770 488-4472 dwh6@cdc.gov
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
08/25/2011
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