CONGENITAL SYPHILIS CASE INVESTIGATION AND REPORTING FORM

ICR 199403-0920-004

OMB: 0920-0128

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0920-0128 199403-0920-004
Historical Active 199103-0920-001
HHS/CDC
CONGENITAL SYPHILIS CASE INVESTIGATION AND REPORTING FORM
Revision of a currently approved collection   No
Regular
Approved without change 05/23/1994
Retrieve Notice of Action (NOA) 03/01/1994
  Inventory as of this Action Requested Previously Approved
05/31/1997 05/31/1997 05/31/1994
3,500 0 3,500
875 0 875
0 0 0

THIS DATA COLLECTION WILL PROVIDE A SURVEILLANCE SYSTEM FOR CONGENITAL SYPHILIS (CS). THE DATA WILL BE USED TO MONITOR LEVELS OF DISEASE, DEVELOP INTERVENTION STRATEGIES, AND TO EVALUATE ONGOING CONTROL EFFORTS. THIS REQUEST INCLUDES A REVISION OF THE CASE DEFINITION WHIC MONITORS MOTHERS WITH UNTREATED SYPHILIS RATHER THAN INFANTS WITH CLINICAL SIGNS AND SYMPTOMS OF CS.

None
None


No

1
IC Title Form No. Form Name
CONGENITAL SYPHILIS CASE INVESTIGATION AND REPORTING FORM 73.126

  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 3,500 3,500 0 0 0 0
Annual Time Burden (Hours) 875 875 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
03/01/1994


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