Emerging Infections Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
FluSurv-Net Project Consent Form	Form	Modified	Available
Influenza Hospitalization Surveillance Project Vaccination Telephone Survey	Form	Modified	Available
FluSurv-NET Influenza Hospitalization Surveilance Project Case Report Form	Form	Modified	Available
Legionellosis ABCs Case Report	Form	Modified	Available
ABCs Neonatal Infection Expanded Tracking Form	Form	Modified	Available
Invasive Methicillin - Resistant - Staphylococcus aureus ABCs Case Report Form	Form	Modified	Available
ABCs Case Report Form	Form	Modified	Repair queued
EIP February 2014 Change Request.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2014-02-27	Available
Attachment5_FoodNet Variable List_2014_12312013_Feb2014.pdf	Supplementary Document	Uploaded 2014-02-27	Available
Attachment10_FluSurv-NET Influenza Surveillance Project Consent SPAN_Feb....pdf	Supplementary Document	Uploaded 2014-02-27	Available
Attachment8_FluSurv-NET Influenza Surveillance Project TeleSurvSPAN_Feb2....pdf	Supplementary Document	Uploaded 2014-02-27	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
207663	Yersinia	Other-WORD	Modified
207662	Vibrio	Other-WORD	Modified
207661	Shigella	Other-WORD	Modified
207660	Shiga toxin producing E. coli	Other-WORD	Modified
207659	Salmonella	Other-WORD	Modified
207658	Listeria monocytogenes	Other-WORD	Modified
207657	Cyclospora	Other-WORD	Modified
207656	Cryptosporidium	Other-WORD	Modified
207655	Campylobacter	Other-WORD	Modified
207654	FluSurv-Net Project Consent Form	Form	Modified
207653	Influenza Hospitalization Surveillance Project Vaccination Telephone Survey	Form	Modified
207652	Hemolytic Uremic Syndrome (HUS)	Other-WORD	Modified
207651	FluSurv-NET Influenza Hospitalization Surveilance Project Case Report Form	Form	Modified
207650	Legionellosis ABCs Case Report	Form	Modified
207649	ABCs Neonatal Infection Expanded Tracking Form	Form	Modified
207648	ABCs Invasive Pneumococcal Disease in Children	Other-WORD	Modified
207647	Invasive Methicillin - Resistant - Staphylococcus aureus ABCs Case Report Form	Form	Modified
207646	ABCs Case Report Form	Form	Modified

ICR Details

OMB Control No: 0920-0978	ICR Reference No: 201402-0920-016
Status: Historical Active	Previous ICR Reference No: 201309-0920-007
Agency/Subagency: HHS/CDC	Agency Tracking No: 21493
Title: Emerging Infections Program
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/06/2014
	Date Received in OIRA: 02/28/2014
Terms of Clearance: Previous terms continue: Approved consistent with the understanding that this consolidation will result in the modification and/or discontinuation of related CDC ICRs.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2016	08/31/2016	08/31/2016
Responses	41,200	0	41,200
Time Burden (Hours)	12,319	0	12,319
Cost Burden (Dollars)	0	0	0

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Abstract: CDC is requesting minor changes for 2014 reporting of diseases reported under the Emerging Infections Program.

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Authorizing Statute(s): US Code: 42 USC 301 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 18

table that charts list of burden

IC Title	Form No.	Form Name
ABCs Case Report Form	none	ABC's Case Report Form
Invasive Methicillin - Resistant - Staphylococcus aureus ABCs Case Report Form	none	Invasive Methicillin-Resistant Staph
ABCs Invasive Pneumococcal Disease in Children
ABCs Neonatal Infection Expanded Tracking Form	none	Neonatal Tracking
Legionellosis ABCs Case Report	none	Legionellosis Case Report
FluSurv-NET Influenza Hospitalization Surveilance Project Case Report Form	none	FluSurv-NET Case Report
Hemolytic Uremic Syndrome (HUS)
Influenza Hospitalization Surveillance Project Vaccination Telephone Survey	none	FluSurv-NET Vac History Phone
FluSurv-Net Project Consent Form	none	Consent Form
Campylobacter
Cryptosporidium
Cyclospora
Listeria monocytogenes
Salmonella
Shiga toxin producing E. coli
Shigella
Vibrio
Yersinia

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ICR Summary of Burden

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	41,200	41,200	0	0	0	0
Annual Time Burden (Hours)	12,319	12,319	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $6,872,123

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 02/28/2014

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