0920-0004 Foodborne Outbreak 52.13

National Disease Surveillance Program - II. Disease Summaries

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0004 can be found here:

Documents and Forms

Document Name Document Type
FoodborneOutbreak Form 5213.pdf Instruction
FoodborneOutbreak Form 5213 ReportingInstructions.pdf Foodborne Outbreak Reporting Instructions IC Document

Information Collection (IC) Details

IC Title:	0920-0004 Foodborne Outbreak 52.13	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
Instruction			FoodborneOutbreak Form 5213.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 54	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,350	1,350
Annual IC Time Burden (Hours)	338	338
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Foodborne Outbreak Reporting Instructions	FoodborneOutbreak Form 5213 ReportingInstructions.pdf	01/17/2007

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