National Disease Surveillance Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form none assigned Viral Hepatitis	Form	Removed	Available
Form none assigned Typhoid Fever	Form	Removed	Available
Form none assigned Tularemia	Form	Modified	Available
Form none assigned Trichinosis	Form	Modified	Repair queued
Form none assigned Tick-Borne	Form	Modified	Available
Form none assigned Reye Syndrome	Form	Modified	Available
Form none assigned Q Fever	Form	Modified	Available
Form none assigned Plague	Form	Modified	Available
Form CDC 54.1 Malaria Case Surveillance Report	Form	Modified	Available
Form none assigned Lyme Disease	Form	Modified	Available
Form none assinged Legionellosis	Form	Modified	Repair queued
Form none assigned Kawasaki	Form	Modified	Repair queued
Form none assigned Hantavirus	Form	Modified	Available
Form none assigned Dengue-Spanish	Form	Modified	Available
Form none assigned Dengue	Form	Modified	Repair queued
Form none assigned Cyclosporiasis	Form	Modified	Available
Form none assigned CJD	Form	Modified	Available
Form No number Hepatitis Case Record	Form	Modified	Available
Form No number Typhoid Fever Surveillance	Form	Modified	Available
Public Health Service Act Sec 301 and 306.docx	Supplementary Document	Uploaded 2010-03-02	Available
Attachment C Surveillance Summaries.docx	Supplementary Document	Uploaded 2010-02-25	Available
Published 60day FRN.pdf	Supplementary Document	Uploaded 2010-02-25	Available
CDCMalaria54 1_changesAppenA2009.xls	Supplementary Document	Uploaded 2010-02-25	Available
Currentmalaria_form.pdf	Supplementary Document	Uploaded 2010-02-25	Repair queued
DCIF_English_Color_proposed_jun2009.ppt	Supplementary Document	Uploaded 2009-06-08	Available
Supporting_Statement_0920-0009_Feb23 2010.docx	Supporting Statement A	Uploaded 2010-02-25	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
46214	National Disease Surveillance Program - 1_Viral Hepatitis Case Record	Form	Removed	Viral Hepatitis
46213	National Disease Surveillance Program - 1_Typhoid Fever Surveillance Report	Form	Removed	Typhoid Fever
46212	Tularemia	Form	Modified	Tularemia
46211	Trichinosis Surveillance Case Report	Form	Modified	Trichinosis
46210	Tick-borne Rickettsial Disease Case Report	Form	Modified	Tick-Borne
46209	Reye Syndrome Case Surveillance Report	Form	Modified	Reye Syndrome
46208	Q Fever	Form	Modified	Q Fever
46207	Plaque Case Investigation Report	Form	Modified	Plague
46206	Malaria Case Surveillance Report	Form	Modified	Malaria Case Surveillance Report
46205	Lyme Disease Report	Form	Modified	Lyme Disease
46204	Legionellosis Case Report	Form	Modified	Legionellosis
46203	Kawasaki Syndrome	Form	Modified	Kawasaki
46202	Hantavirus Pulmonary Syndrome	Form	Modified	Hantavirus
46201	Dengue Case Investigation	Form	Modified	Dengue-Spanish
46201	Dengue Case Investigation	Form	Modified	Dengue
46200	Cyclosporiasis	Form	Modified	Cyclosporiasis
46199	CJD	Form	Modified	CJD
46198	Viral Hepatitis Case Record	Form	Modified	Hepatitis Case Record
37710	Typhoid Fever Surveillance Report	Form	Modified	Typhoid Fever Surveillance

ICR Details

OMB Control No: 0920-0009	ICR Reference No: 201003-0920-010
Status: Historical Active	Previous ICR Reference No: 200906-0920-018
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: National Disease Surveillance Program
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/30/2010
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/23/2010
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2013	36 Months From Approved	04/30/2010
Responses	45,145	0	56,666
Time Burden (Hours)	11,447	0	13,368
Cost Burden (Dollars)	0	0	0

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Abstract: The National Disease Surveillance Program 1. Case Reports is an ongoing surveillance activity of the Centers for Disease Control and Prevention (CDC). This request is for revisions which remove two Active Bacterial Surveillance forms and request minor changes to the Malaria Case Surveillance Report form.

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Authorizing Statute(s): US Code: 42 USC 301 Name of Law: General Powers and Duties of Public Health Service
   US Code: 42 USC 306 Name of Law: National Center for Health Statistics
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 66975	12/17/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 9902	03/04/2010
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 16

table that charts list of burden

IC Title	Form No.	Form Name
CJD	none assigned	CJD
Cyclosporiasis	none assigned	Cyclosporiasis
Dengue Case Investigation	none assigned, none assigned	Dengue ,   Dengue-Spanish
Hantavirus Pulmonary Syndrome	none assigned	Hantavirus
Kawasaki Syndrome	none assigned	Kawasaki
Legionellosis Case Report	none assinged	Legionellosis
Lyme Disease Report	none assigned	Lyme Disease
Malaria Case Surveillance Report	CDC 54.1	Malaria Case Surveillance Report
National Disease Surveillance Program - 1_Typhoid Fever Surveillance Report	none assigned	Typhoid Fever
National Disease Surveillance Program - 1_Viral Hepatitis Case Record	none assigned	Viral Hepatitis
Plaque Case Investigation Report	none assigned	Plague
Q Fever	none assigned	Q Fever
Reye Syndrome Case Surveillance Report	none assigned	Reye Syndrome
Tick-borne Rickettsial Disease Case Report	none assigned	Tick-Borne
Trichinosis Surveillance Case Report	none assigned	Trichinosis
Tularemia	none assigned	Tularemia
Typhoid Fever Surveillance Report	No number	Typhoid Fever Surveillance
Viral Hepatitis Case Record	No number	Hepatitis Case Record

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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	45,145	56,666	0	-11,521	0	0
Annual Time Burden (Hours)	11,447	13,368	0	-1,921	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The decrease in burden hours is due to removal of the ABCs forms and rounding of responses previously submitted with decimals.

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Annual Cost to Federal Government: $80,000

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)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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: 03/23/2010

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