Syndromic Surveillance: Success Stories from the Field from NSSP Awardees

Information Collections to Advance State, Tribal, Local and Territorial (STLT) Governmental Agency System Performance, Capacity, and Program Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0879 can be found here:

Documents and Forms

Document Name Document Type
Form Attachment C Syndromic Surveillance: Success Stories from the Field from NSSP Awardees Form
Attachment C Screen Shots of the Web-based Success Story Template Attachment C - Web Version SYSSSFFTemplate.docx Form
SYS_SS-TIP_SSA_NSSPAwardees.docx Supporting Statement A IC Document
SYS_SS_TIP_SSB_NSSPAwardees.docx Supporting Statement B IC Document
Attachment A - Table A-1 Respondent Universe.docx Attachment A. Respondent Universe IC Document
Attachment B - Word Version SySSSFFTemplate.docx Attachment B. Success Story Template-Word version for content review IC Document
Attachment D - Script for SySSSFFTemplate_Awardees.docx Attachment D. Script for Announcing the Success Story Template IC Document

Information Collection (IC) Details

IC Title:	Syndromic Surveillance: Success Stories from the Field from NSSP Awardees	Agency IC Tracking Number:	0920-16BFC

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	Attachment C	Screen Shots of the Web-based Success Story Template	Attachment C - Web Version SYSSSFFTemplate.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 31	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	31	31
Annual IC Time Burden (Hours)	52	52
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement A	SYS_SS-TIP_SSA_NSSPAwardees.docx	09/26/2016
Supporting Statement B	SYS_SS_TIP_SSB_NSSPAwardees.docx	09/26/2016
Attachment A. Respondent Universe	Attachment A - Table A-1 Respondent Universe.docx	09/26/2016
Attachment B. Success Story Template-Word version for content review	Attachment B - Word Version SySSSFFTemplate.docx	09/26/2016
Attachment D. Script for Announcing the Success Story Template	Attachment D - Script for SySSSFFTemplate_Awardees.docx	09/26/2016

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.