Contact investigation Outcome Reporting Forms

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
SupSta B_11BF_060111.docx	Supporting Statement B	Uploaded 2011-06-24	Available
Att H_Published 60d FRN.pdf	Supplementary Document	Uploaded 2011-06-24	Available
Att A- Section 361 PHS Act.doc	Supplementary Document	Uploaded 2011-06-24	Available
SupSta A_11BF_060111.docx	Supporting Statement A	Uploaded 2011-06-24	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
197948	Optional General Maritime Contact Investigation Outcome Reporting Form	Other-WORD	Modified
197947	Optional General Air/Land Contact Investigation Outcome Reporting Form	Other-WORD	Modified
197946	Optional Measles, Mumps, or Rubella Maritime Contact Investigation Outcome Reporting Form	Other-WORD	Modified
197945	Optional Measles, Mumps or Rubella Air/Land Contact Investigation Outcome Reporting Form	Other-WORD	Modified
197944	Optional TB Maritime Contact Investigation Outcome Reporting Form	Other-WORD	Modified
197943	Optional TB Air/Land Contact Investigaiton Outcome Reporting Form	Other-WORD	Modified

ICR Details

OMB Control No: 0920-0900	ICR Reference No: 201106-0920-017
Status: Historical Active	Previous ICR Reference No: 201106-0920-007
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Contact investigation Outcome Reporting Forms
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/05/2011
	Date Received in OIRA: 06/27/2011
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2014	36 Months From Approved
Responses	3,347	0	0
Time Burden (Hours)	280	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: CDC's Division of Global Migration and Quarantine has developed contact investigation outcome reporting forms for the different types of investigations. This new data collection called "Contact Investigation Outcome Reporting Form supports the need for CDC Quarantine staff to evaluate its contact investigation investigative protocols and in determining if adequate information on each contact was provided to those responsible for contacting passengers believed to have been exposed to a communicable disease during travel.

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Authorizing Statute(s): None

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 8057	12/22/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 29243	05/20/2011
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 6

table that charts list of burden

IC Title	Form No.	Form Name
Optional TB Air/Land Contact Investigaiton Outcome Reporting Form
Optional TB Maritime Contact Investigation Outcome Reporting Form
Optional Measles, Mumps or Rubella Air/Land Contact Investigation Outcome Reporting Form
Optional Measles, Mumps, or Rubella Maritime Contact Investigation Outcome Reporting Form
Optional General Air/Land Contact Investigation Outcome Reporting Form
Optional General Maritime Contact Investigation Outcome Reporting Form

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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	3,347	0	0	3,347	0	0
Annual Time Burden (Hours)	280	0	0	280	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: No

Burden Reduction Due to:

Short Statement: This is a NEW information collection request.

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Annual Cost to Federal Government: $8,211

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? Yes

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]? No

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: 06/27/2011

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