Information Collection

Weekly Influenza-like Illness Oct - May 55.20

IC 195432 under ICR 201011-0920-006 · OMB 0920-0004.

⚠️ Notice: This information collection may be referencing outdated material.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
Form 55.20 Weekly Influenza-like Illness Oct - May 55.20 Form
55.20 Weekly Influenza-like Illness Weekly ILI Reporting Form_55.20.doc Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Weekly Influenza-like Illness Oct - May 55.20	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	55.20	Weekly Influenza-like Illness	Weekly ILI Reporting Form_55.20.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 540	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 87 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	17,820	17,820
Annual IC Time Burden (Hours)	4,455	4,455
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.