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HABISS Monthly Reporting Form
National Disease Surveillance Program - II. Disease Summaries
OMB: 0920-0004
IC ID: 186749
OMB.report
HHS/CDC
OMB 0920-0004
ICR 201005-0920-006
IC 186749
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0004 can be found here:
2024-05-07 - No material or nonsubstantive change to a currently approved collection
2023-01-27 - Reinstatement with change of a previously approved collection
Documents and Forms
Document Name
Document Type
Form No Number
HABISS Monthly Reporting Form
Form
No Number HABISS Report
Attachment 4 0920 0004 Change Request 9 22 08.doc
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
HABISS Monthly Reporting Form
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
Form
No Number
HABISS Report
Attachment 4 0920 0004 Change Request 9 22 08.doc
Yes
Yes
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
09-20-0136 Epidemiologic Studies and Surveillance of Disease Problems
FR Citation:
57 FR 62812
Number of Respondents:
10
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
120
0
0
0
0
120
Annual IC Time Burden (Hours)
60
0
0
0
0
60
Annual IC Cost Burden (Dollars)
0
0
0
0
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.