State Health Departments

Nationally Notifiable Sexually Transmitted Disease (STD) Morbidity Surveillance

Documents and Forms

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

Information Collection (IC) Details

IC Title:	State Health Departments	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	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 %

	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

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.