National Disease Surveillance Program - II. Disease Summaries

Forms and Documents

Document Name	Status
Form No Number HABISS Monthly Reporting Form Form	Modified
Form No number HABISS Form	Modified
Form CDC 52.12 0920-0004 Waterborne Diseases Outbreak 52.12 Form	Modified
Form 1 0920-0004 Diarrheal Diseases Campylobacter Form	Modified
Att B -Disease Summaries.doc Supplementary Document	2010-05-05
Attachment A Sec. 301 42 USC 241.pdf Supplementary Document	2010-05-04
Published 60-day.pdf Supplementary Document	2010-05-04
NORS Form.pdf Supplementary Document	2008-12-22
FoodborneOutbreak Form 5213 ReportingInstructions.pdf Supplementary Document	2007-01-17
NREVSS PCR Worksheet CDC 55.83D.pdf Supplementary Document	2007-01-17
NREVSS VI Worksheet CDC 55.83B.pdf Supplementary Document	2007-01-17
NREVSS EM Worksheet CDC 55.83C.pdf Supplementary Document	2007-01-17
0920-0004 2010 revised May 25.doc Supporting Statement A	2010-05-25

IC Document Collections

IC ID	Document Title	Status
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: 201005-0920-006
Status: Historical Active	Previous ICR Reference No: 200901-0920-004
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: National Disease Surveillance Program - II. Disease Summaries
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/23/2010
	Date Received in OIRA: 05/26/2010
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2013	36 Months From Approved	06/30/2010
Responses	154,295	0	154,295
Time Burden (Hours)	22,356	0	22,356
Cost Burden (Dollars)	0	0	0

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Abstract: Data on disease and preventable conditions are collected in accordance with jointly approved plans by the Center for Disease Control and Prevention and the Council of State and Territorial Health Epidemiologists.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act
  

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:
	75 FR 382	01/05/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 26256	05/11/2010
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
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
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

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ICR Summary 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	154,295	0	0	0	0
Annual Time Burden (Hours)	22,356	22,356	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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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]? No

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: 05/26/2010

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