Congenital Syphilis Case Investigation and Report Form

ICR 201212-0920-005

OMB: 0920-0128

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Form
Modified
Form
Modified
Supporting Statement B
2012-12-10
Supplementary Document
2012-12-05
Supplementary Document
2012-12-05
Supplementary Document
2012-12-05
Supplementary Document
2012-12-05
Supplementary Document
2012-12-05
Supplementary Document
2012-12-05
Supporting Statement A
2012-12-05
ICR Details
0920-0128 201212-0920-005
Historical Active 201002-0920-007
HHS/CDC
Congenital Syphilis Case Investigation and Report Form
Revision of a currently approved collection   No
Regular
Approved without change 01/09/2013
Retrieve Notice of Action (NOA) 12/10/2012
  Inventory as of this Action Requested Previously Approved
01/31/2016 36 Months From Approved 03/31/2013
187 0 187
63 0 63
0 0 0

A reporting form for congenital syphilis (CDC Form 73.126) was initiated in 1983 to improve detection, case management, and treatment of congenital syphilis cases. The CDC continues to gather and report information on congenital syphilis morbidity as part of its ongoing Sexually Transmitted Disease (STD) surveillance efforts. This request includes numerous variable changes to collect pertinent data and enable appropriate classification of congenital syphilis cases.

US Code: 42 USC 241 Name of Law: Public Health Service Act
  
None

Not associated with rulemaking

  77 FR 47072 08/07/2012
77 FR 73470 12/10/2012
No

  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 187 187 0 0 0 0
Annual Time Burden (Hours) 63 63 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$97,057
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Shari Steinberg 404 639-4942 [email protected]

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
12/10/2012


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