0920-0004 Waterborne Diseases Outbreak 52.12

National Disease Surveillance Program - II. Disease Summaries

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0004 can be found here:

Documents and Forms

Document Name Document Type
Form CDC.52.12 0920-0004 Waterborne Diseases Outbreak 52.12 Form
CDC.52.12 National Outbreak Reporting System: Waterborne Disease T Revised CDC 52.12 form Feb 2013.pdf Form

Information Collection (IC) Details

IC Title:	0920-0004 Waterborne Diseases Outbreak 52.12	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	CDC.52.12	National Outbreak Reporting System: Waterborne Disease Transmission	Revised CDC 52.12 form Feb 2013.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 59	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	59	2	57
Annual IC Time Burden (Hours)	20	1	19
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.