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State Epidemiologists
Centers for Disease Control and Prevention (CDC) Secure Communications Network (Epi-X)
OMB: 0920-0636
IC ID: 7104
OMB.report
HHS/CDC
OMB 0920-0636
ICR 201012-0920-005
IC 7104
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0636 can be found here:
2014-03-14 - Revision of a currently approved collection
2011-04-25 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Form 1
State Epidemiologists
Form
1 Epi X Customer Survey
Attachment 3 Epi X survey.docx
Form
2 Immunization and Respiratory Diseases
Attachment 4 Survey Questions. A docx.docx
Form
3 Environmental Health
Attachment 5 questions NCHE_ATSDR mtw 17 Sept. A docx.docx
Form
4 Arborviral Diseases
Attachment 6 Survey Questions_Arboviral Diseases .doc
Form
5 Global Migration and Quarantine
Attachment 7 DGMQ Questions mtw 17 Sept. A docx.docx
Form
6 Rabies
Attachment 8 Rabies.docx
Form
7 Health Quality Promotion
Attachment 9 Div Hty Quality Questions.docx
Form
Attachment 10 webpage privacy policy.docx
Attachment 10 webpage privacy policy
IC Document
Attachment 11 Email Script.docx
Attachment 11 Email Script
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
State Epidemiologists
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
1
Epi X Customer Survey
Attachment 3 Epi X survey.docx
Yes
Yes
Fillable Fileable
Form
2
Immunization and Respiratory Diseases
Attachment 4 Survey Questions. A docx.docx
Yes
Yes
Fillable Fileable
Form
3
Environmental Health
Attachment 5 questions NCHE_ATSDR mtw 17 Sept. A docx.docx
Yes
Yes
Fillable Fileable
Form
4
Arborviral Diseases
Attachment 6 Survey Questions_Arboviral Diseases .doc
Yes
Yes
Fillable Fileable
Form
5
Global Migration and Quarantine
Attachment 7 DGMQ Questions mtw 17 Sept. A docx.docx
Yes
Yes
Fillable Fileable
Form
6
Rabies
Attachment 8 Rabies.docx
Yes
Yes
Fillable Fileable
Form
7
Health Quality Promotion
Attachment 9 Div Hty Quality Questions.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
50
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
100 %
Requested
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
5,200
0
4,200
0
0
1,000
Annual IC Time Burden (Hours)
5,200
0
5,033
0
0
167
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Attachment 10 webpage privacy policy
Attachment 10 webpage privacy policy.docx
11/15/2010
Attachment 11 Email Script
Attachment 11 Email Script.docx
11/15/2010
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.