Information Collection Request

Emergency Epidemic Investigation Data Collections - Expedited Reviews

ICR 201311-0920-016 · OMB 0920-1011 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Suicide _VA Form New Available
CCRF_Georgia Form New Repair queued
Ebola_TX Form and Instruction New Available
Ebola_West Africa_2014 Form and Instruction New Available
Pediatric cluster of neurologic symptoms - Colorado Form New Available
BSI_CA Form New Available
2014015-XXX_Parechovirus_Multi Form New Available
2014011-XXX Ebola_Liberia Form New Available
Form 0920-1011 2014010-XXX Ebola_Guinea Form and Instruction New Available
2014008-XXX Chikungunya_PR Form New Repair queued
2014005XXX_DiarrhealDisease_AS Form New Available
2014004XXX_Legionnaires' Disease_Alabama 2014 Form New Available
2014E003XXX_MERS-CoV_GA Form New Available
EEI GenICR_Sup St B_3_20_14.docx Supporting Statement B Uploaded 2014-03-25 Available
EEI GenICR 0920-13ZJ_App 6_Online Survey Case Finding Questionnaire_11-06-2013.docx Supplementary Document Uploaded 2013-11-20 Available
EEI GenICR 0920-13ZJ_App 5_Phone Interview Questionnaire Patient_11-06-2013_Subm.docx Supplementary Document Uploaded 2013-11-20 Available
EEI GenICR 0920-13ZJ_App 4_Q Fever Person Interview Questionnaire_11-14-2013_Subm.docx Supplementary Document Uploaded 2013-11-20 Available
EEI GenICR 0920-13ZJ_App 3 _Hantav Pulm Synd Questionnaire_11-14-2013_Subm.docx Supplementary Document Uploaded 2013-11-20 Repair queued
EEI GenICR 0920-13ZJ_App 2_GBS Case Questionnaire_11-14-2013_Subm.docx Supplementary Document Uploaded 2013-11-20 Available
EEI GenICR 0920-13ZJ_App 1_Chart Abstract Form_11-14-2013_Subm.docx Supplementary Document Uploaded 2013-11-20 Available
EEI GenICR 0920-13ZJ_Attach H_Biospecimen Storage Consent_11-06-2013_Subm.docx Supplementary Document Uploaded 2013-11-20 Repair queued
EEI GenICR_0920-13ZJ_Attach G _Emer Epi Invest_IRB Letter_11-06-2013_Subm.pdf Supplementary Document Uploaded 2013-11-20 Available
EEI Gen ICR 0920-13ZJ_Attach F_Epi Invest SORN_11-06-2013.doc Supplementary Document Uploaded 2013-11-20 Available
EEI GenICR 0920-13ZJ_Attach E _Burden Memo_3-20-14.docx Supplementary Document Uploaded 2014-03-25 Available
EEI_Attach D_Request for Approval_3_20_14.docx Supplementary Document Uploaded 2014-03-25 Available
EEI GenICR 0920-13ZJ_Attach C_ Steps Conduct Emer Epi Invest_3_20_14.docx Supplementary Document Uploaded 2014-03-25 Available
EEI GenICR_0920-13ZJ_Attach B _Emer Epi Invest_Pub 60-day FRN_11-06-2013_Subm.pdf Supplementary Document Uploaded 2013-11-20 Available
EEI GenICR_0920-13ZJ_Attach A_Auth Legis Emer Epi Invest_11-06-2013_Subm.pdf Supplementary Document Uploaded 2013-11-20 Repair queued
EEI_GenICR_Sup St A_3_20_14.docx Supporting Statement A Uploaded 2014-03-25 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
213737 Suicide _VA Form New
213373 CCRF_Georgia Form New
213323 Ebola_TX Form and Instruction New
213274 Ebola_West Africa_2014 Form and Instruction New
213233 Pseudomonas NICU_CA Other-WORD New
213189 Pediatric cluster of neurologic symptoms - Colorado Form New
213101 BSI_CA Form New
212908 2014016-XXX_Ebola_DRC Other-WORD New
212644 2014015-XXX_Parechovirus_Multi Form New
212395 2014014-XXX Ebola_Sierra Leone Other-PDF New
212348 2014013-XXX_Resp Illness UAC_Multi Other-WORD New
212320 2014012-XXX Resp Illness UC_CA Other-WORD New
212266 2014011-XXX Ebola_Liberia Form New
212227 2014009-XXX_Chikungunya_US Service Org Volunteers New
212127 2014010-XXX Ebola_Guinea Form and Instruction New
211951 2014008-XXX Chikungunya_PR Form New
211894 Chikungunya_USVI Other-WORD New
211760 20140006XXX Measles FSM Other-WORD New
211705 2014005XXX_DiarrhealDisease_AS Form New
211702 2014004XXX_Legionnaires' Disease_Alabama 2014 Form New
211682 2014E003XXX_MERS-CoV_GA Form New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
03/31/2017 36 Months From Approved
36,000 0 0
18,000 0 0
0 0 0





Reginfo record details
21
table that charts list of burden
IC Title Form No. Form Name
2014009-XXX_Chikungunya_US Service Org Volunteers
Pediatric cluster of neurologic symptoms - Colorado none, none Medical Chart Abstraction ,   Family Interview Questionnaire
2014010-XXX Ebola_Guinea 0920-1011, 0920-1011 Appendix 1- Case Investigation Form ,   Appendix 2- Contact Tracing Form
Ebola_TX None, None Appendix 2 - Ebola Case Contact Questionnaire ,   Appendix 1 - Ebola Case Investigation Form
2014004XXX_Legionnaires' Disease_Alabama 2014 none, none Record Abstraction ,   Interview Questionnaire
BSI_CA none, none, none Chart Abstraction ,   Outpatient Dialysis Practices Survey ,   Reprocessing Observation Checklist
Ebola_West Africa_2014 none, none, none Observation Guide ,   Field Guide ,   Focus Group Guide
Pseudomonas NICU_CA
2014E003XXX_MERS-CoV_GA none, none Questionnaire for Passengers and Crew ,   Follow-up Questionnaire for Asymptomatic Passengers and Crew
2014012-XXX Resp Illness UC_CA
2014005XXX_DiarrhealDisease_AS none, none Medical Abstraction Form ,   Case Questionnaire
20140006XXX Measles FSM
2014016-XXX_Ebola_DRC
2014015-XXX_Parechovirus_Multi none, none Chart Abstraction ,   Family interview
CCRF_Georgia none, none, none KAP Survey ,   Case Investigation ,   Consent
Chikungunya_USVI CDC 56.31 A REV. 06/2006 Dengue Case Investigation Report
2014008-XXX Chikungunya_PR none, none, none, none Household Questionnaire ,   Individual Questionnaire ,   Case Report (English) ,   Case Report (Spanish)
2014014-XXX Ebola_Sierra Leone
Suicide _VA none, none Interview Guide ,   Focus Group Guide
2014011-XXX Ebola_Liberia none, none Case Report Form ,   Contact Listing Form
2014013-XXX_Resp Illness UAC_Multi

table that charts list of burden
  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 36,000 0 0 36,000 0 0
Annual Time Burden (Hours) 18,000 0 0 18,000 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No