Syndromic Surveillance: Success Stories from the Field Guide from Not CDC Funded State & Local Health Departments

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⚠️ Notice: This information collection may be referencing outdated material.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 Guide from Not CDC Funded State & Local Health Departments Form
Attachment C Screen Shots of the Web-based SySSSFF Template Attachment C - Web Version SYSSSFFTemplate.docx Form
Attachment D- Script for SySSSFFTemplate_NotCDCfunded.docx Script for Announcing SS to non-CDC Funded HD IC Document
Attachment B - Word Version SySSSFFTemplate.docx Word File Displaying Content of the Web-based SySSSFF Template IC Document
Attachment A - Table A-1 Respondent Universe.docx Attachment A. Respondent Universe IC Document
SYS_SS-TIP_SSA_NotCDCFunded State_Local.docx Supporting Statement A IC Document
SYS_SS_TIP_SSB_NotCDCFunded_State_Local.docx Supporting Statement B IC Document

Information Collection (IC) Details

IC Title:	Syndromic Surveillance: Success Stories from the Field Guide from Not CDC Funded State & Local Health Departments	Agency IC Tracking Number:	0920-16BDR

IC Status: New

Obligation to Respond: Voluntary

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 SySSSFF 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: 34	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	34	34
Annual IC Time Burden (Hours)	57	57
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Script for Announcing SS to non-CDC Funded HD	Attachment D- Script for SySSSFFTemplate_NotCDCfunded.docx	09/23/2016
Word File Displaying Content of the Web-based SySSSFF Template	Attachment B - Word Version SySSSFFTemplate.docx	09/23/2016
Attachment A. Respondent Universe	Attachment A - Table A-1 Respondent Universe.docx	09/23/2016
Supporting Statement A	SYS_SS-TIP_SSA_NotCDCFunded State_Local.docx	09/26/2016
Supporting Statement B	SYS_SS_TIP_SSB_NotCDCFunded_State_Local.docx	09/26/2016

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