Information Collection

Syndromic Surveillance: Success Stories from the Field from NSSP Awardees

IC 223690 under ICR 201412-0920-011 · OMB 0920-0879.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.