National Disease Surveillance Program - II. Disease Summaries

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form No Number HABISS Monthly Reporting Form	Form	Modified	Repair queued
Form No number HABISS	Form	Modified	Available
Form CDC 52.12 0920-0004 Waterborne Diseases Outbreak 52.12	Form	Modified	Available
Form 1 0920-0004 Diarrheal Diseases Campylobacter	Form	Modified	Available
Justification for change in responses from eFORS to NORS.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2008-12-22	Available
Changes from eFORS to NORS form.pdf	Supplementary Document	Uploaded 2008-12-22	Available
NORS Form.pdf	Supplementary Document	Uploaded 2008-12-22	Available
FoodborneOutbreak Form 5213 ReportingInstructions.pdf	Supplementary Document	Uploaded 2007-01-17	Available
NREVSS PCR Worksheet CDC 55.83D.pdf	Supplementary Document	Uploaded 2007-01-17	Available
NREVSS EM Worksheet CDC 55.83C.pdf	Supplementary Document	Uploaded 2007-01-17	Available
NREVSS VI Worksheet CDC 55.83B.pdf	Supplementary Document	Uploaded 2007-01-17	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
37707	0920-0004 Influenza Annual Survey 55.31A	Instruction	Modified
186749	HABISS Monthly Reporting Form	Form	Modified
186748	HABISS	Form	Modified
178378	0920-0004 Influenza Virus PHLIS (year-round) electronic	Instruction	Modified
178377	0920-0004 Influenza Virus PHLIS (Oct-May) electronic	Instruction	Modified
178376	0920-0004 Influenza Virus 55.31 (fax and internet year-round)	Instruction	Modified
178375	0920-0004 Listeria Case Form	Instruction	Modified
178374	0920-0004 Suspected Viral Gastroenteritis (AKA Calicivirus Surveillance)	Instruction	Modified
178373	0920-0004 Cholera and Other Vibrio Illnesses 52.79	Instruction	Modified
178372	0920-0004 Waterborne Diseases Outbreak 52.12	Form	Modified
178371	0920-0004 Rabies Monthly Report (electronic)	Instruction	Modified
178370	0920-0004 Rabies Monthly Report (paper) 55.28	Instruction	Modified
178369	0920-0004 Foodborne Outbreak 52.13	Instruction	Modified
178368	0920-0004 Influenza-Like Illness (year-round) 55.20E	Instruction	Modified
178367	0920-0004 Influenza-Like Illness (Oct-May) 55.20	Instruction	Modified
178366	0920-0004 Influenza Virus 55.31 (fax and internet Oct-May)	Instruction	Modified
178365	0920-0004 National Respiratory and Enteric Virus Surveillance System NREVSS 55.83A-D	Instruction	Modified
178364	0920-0004 National Enterovirus Surveillance Report 55.9	Instruction	Modified
178363	0920-0004 Arboviral Diseases	Instruction	Modified
178362	0920-0004 Diarrheal Diseases Shigella	Instruction	Modified
178361	0920-0004 Diarrheal Diseases Salmonella	Instruction	Modified
178360	0920-0004 Diarrheal Diseases Campylobacter	Form	Modified

ICR Details

OMB Control No: 0920-0004	ICR Reference No: 200901-0920-004
Status: Historical Active	Previous ICR Reference No: 200809-0920-003
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: National Disease Surveillance Program - II. Disease Summaries
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/22/2009
	Date Received in OIRA: 01/07/2009
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2010	05/31/2010	05/31/2010
Responses	154,295	0	153,944
Time Burden (Hours)	22,356	0	22,127
Cost Burden (Dollars)	0	0	0

---

Abstract: NCEH is requesting that the Harmful Algal Bloom-related Illness Surveillance System (HABISS) be added to the other CDC Surveillance Systems covered under this clearance. The purpose of this information collection is to gather specific data related to harmful algal blooms using the Harmful Algal Bloom-related Illness Surveillance System (HABISS). As is the case for other conditions within the National Disease Surveillance Program, state and territorial epidemiologists and scientists will be responsible for the collection, interpretation, and transmission of medical and epidemiologic information. NCEH will use the information to monitor and analyze this data in order to better understand the impact of algal blooms on the health of the general public.

---

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:
	70 FR 72435	12/05/2005
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 2528	01/19/2007
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 22

table that charts list of burden

IC Title	Form No.	Form Name
0920-0004 Rabies Monthly Report (paper) 55.28
0920-0004 Rabies Monthly Report (electronic)
0920-0004 Waterborne Diseases Outbreak 52.12	CDC 52.12	Waterborne Disease Outbreak Report
0920-0004 Cholera and Other Vibrio Illnesses 52.79
0920-0004 Suspected Viral Gastroenteritis (AKA Calicivirus Surveillance)
0920-0004 Listeria Case Form
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
HABISS	No number	HABISS
HABISS Monthly Reporting Form	No Number	HABISS Report
0920-0004 Influenza Annual Survey 55.31A
0920-0004 Diarrheal Diseases Campylobacter	1	Diarrheal Disease Surveillance Campylobacter
0920-0004 Diarrheal Diseases Salmonella
0920-0004 Diarrheal Diseases Shigella
0920-0004 Arboviral Diseases
0920-0004 National Enterovirus Surveillance Report 55.9
0920-0004 National Respiratory and Enteric Virus Surveillance System NREVSS 55.83A-D
0920-0004 Influenza Virus 55.31 (fax and internet Oct-May)
0920-0004 Influenza-Like Illness (Oct-May) 55.20
0920-0004 Influenza-Like Illness (year-round) 55.20E
0920-0004 Foodborne Outbreak 52.13

---

ICR Summary of Burden

table that charts list 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	154,295	153,944	0	351	0	0
Annual Time Burden (Hours)	22,356	22,127	0	229	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: No

Burden Reduction Due to:

Short Statement: This request will add another surveillance activity under the currently approved ICR. The currently approved burden will increase by 1,020 hours.

---

Annual Cost to Federal Government: $40,000

Does this IC contain surveys, censuses, or employ statistical methods? No

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]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

---

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: 01/07/2009

---