Information Collection

State Health Departments

IC 188706 under ICR 201211-0920-010 · OMB 0920-0819.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form no form number State Health Departments	Form and Instruction
ATT8_Data Screens from STDMIS 5.doc.docx	Other-screen shots example of data s
no form number Information Content of Nationally STD Case Report by Dat ATT3_Data Elements.docx	Form and Instruction
ATT4_CSTEguide.doc ATT4_CSTEguide	IC Document
ATT5_Memo SDMB ResponseOMB Ques.doc ATT5_Memo SDMB ResponseOMB Ques	IC Document
ATT6_Data Infomation Flow.doc ATT6_Data Infomation Flow	IC Document
ATT7_STD_NETSS_record_layout.pdf ATT7_STD_NETSS_record_layout	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	no form number	Information Content of Nationally STD Case Report by Data Element	ATT3_Data Elements.docx		Yes	Yes	Fillable Printable
Other-screen shots example of data screen			ATT8_Data Screens from STDMIS 5.doc.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,600	2,600
Annual IC Time Burden (Hours)	867	867
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
ATT4_CSTEguide	ATT4_CSTEguide.doc	11/19/2012
ATT5_Memo SDMB ResponseOMB Ques	ATT5_Memo SDMB ResponseOMB Ques.doc	11/19/2012
ATT6_Data Infomation Flow	ATT6_Data Infomation Flow.doc	11/19/2012
ATT7_STD_NETSS_record_layout	ATT7_STD_NETSS_record_layout.pdf	11/19/2012

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.