National Disease Surveillance Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form none assigned Reye Syndrome	Form	Removed	Available
Form none assigned Kawasaki	Form	Removed	Repair queued
Form none assigned CJD	Form	Removed	Available
Patient Summary Form	Form	New	Available
0920-0009 Change Request 10 1 2014-final.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2014-10-03	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
46209	Reye Syndrome Case Surveillance Report	Form	Removed	Reye Syndrome
46203	Kawasaki Syndrome	Form	Removed	Kawasaki
46199	CJD	Form	Removed	CJD
213370	Acute Neurological Illness in Children Patient Summary Form	Form	New	Patient Summary Form

ICR Details

OMB Control No: 0920-0009	ICR Reference No: 201410-0920-002
Status: Historical Active	Previous ICR Reference No: 201401-0920-007
Agency/Subagency: HHS/CDC	Agency Tracking No: 15AL
Title: National Disease Surveillance 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: 10/03/2014
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/03/2014
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2016	04/30/2016	04/30/2016
Responses	100	0	530
Time Burden (Hours)	50	0	140
Cost Burden (Dollars)	0	0	0

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Abstract: Due to an urgent need, the CDC is making non-substantial changes to the National Disease Surveillance Program information collection.

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Authorizing Statute(s): US Code: 42 USC 301 Name of Law: General Powers and Duties of Public Health Service
   US Code: 42 USC 306 Name of Law: National Center for Health Statistics
  

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? Yes

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Acute Neurological Illness in Children Patient Summary Form	none	Patient Summary Form
CJD	none assigned	CJD
Kawasaki Syndrome	none assigned	Kawasaki
Reye Syndrome Case Surveillance Report	none assigned	Reye Syndrome

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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	100	530	0	-390	-40	0
Annual Time Burden (Hours)	50	140	0	-77	-13	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: This change requests adds one form and a small increase in burden.

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Annual Cost to Federal Government: $80,000

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: 10/03/2014

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