STD Clinic-based Surveillance

STD Surveillance Network (SSuN)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0842 can be found here:

Documents and Forms

Document Name Document Type
STD Clinic-based Surveillance Form
STD Clinic-based Surveillance SSUN_Attachment 3A_STD Clinic Based Surveillance.doc Form

Information Collection (IC) Details

IC Title:	STD Clinic-based Surveillance	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	STD Clinic-based Surveillance	SSUN_Attachment 3A_STD Clinic Based Surveillance.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 12	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	48	48
Annual IC Time Burden (Hours)	96	96
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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