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⚠️ Notice: This information collection may be referencing outdated material.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
NORS Form.pdf NORS Reporting Form 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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,701	351	1,350
Annual IC Time Burden (Hours)	567	229	338
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Foodborne Outbreak Reporting Instructions	FoodborneOutbreak Form 5213 ReportingInstructions.pdf	01/17/2007
NORS Reporting Form	NORS Form.pdf	12/22/2008

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