Population-based Surveillance

STD Surveillance Network (SSuN)

Documents and Forms

Document Name Document Type
Population-based Surveillance Form and Instruction
Att 3b - Population-based data elements Pop_data_elements_burden.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Population-based Surveillance	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 and Instruction	none	Att 3b - Population-based data elements	Pop_data_elements_burden.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,880	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2,880	0	2,880
Annual IC Time Burden (Hours)	384	48	336
Annual IC Cost Burden (Dollars)	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.