National Disease Surveillance Program - II. Disease Summaries

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CDC 55.31A US WHO Collaborating Laboratories Flu Testing Methods Assessment	Form	Unchanged	Available
Middle East Respiratory Syndrome Coronavirus (MERS) Patient Under Investigation (PUI) Form	Form	Unchanged	Available
Adenovirus Typing Report Form	Form	Unchanged	Available
Antiviral-Resistant Influenza Infection Case Report	Form	Modified	Available
Human Infection with Novel Influenza A Virus Severe Outcomes	Form	Unchanged	Repair queued
Human Infection with Novel Influenza A Virus with Suspected Avian Source	Form	Unchanged	Available
Form CDC 43.5 122 CMRS-City Health Officers or Vital Statistics Registrars Weekly Mortality Report	Form	Unchanged	Available
CMRS Weekly	Form	Unchanged	Available
Form CDC 43.50 122 CMRS -City Health Officers or Vital Statistics Registrars Daily Mortality Report	Form	Unchanged	Available
Form CDC 55.20 US Outpatient Influenza-like Illness Surveillance Network (ILINet) Weekly	Form	Unchanged	Repair queued
US Outpatient Influenza like Illness Surveillance Network (ILINet) Daily Reports	Form	Unchanged	Available
Influenza-Associated Pediatric Mortality Case Report	Form	Modified	Available
Form CDC 55.31 WHO Collaborating Center for Influenza Virus Surveillance (Internet: Year Round)	Form	Unchanged	Available
Aggregate Hospital	Form	Unchanged	Repair queued
Human Infection with Novel Influenza A Virus Case Report Form	Form	Unchanged	Available
Human Infection with Novel Influenza A Virus Case Report Form	Form	Unchanged	Available
Novel Influenza A Virus Infection Contact Tracing Form	Form	Unchanged	Available
Novel Influenza A Virus Case Screening Form	Form	Unchanged	Available
Novel Influenza A Virus Case Status Summary	Form	Unchanged	Available
Form for Submitting Specimens from Suspected Norovirus Outbreaks	Form	Unchanged	Available
Form CDC 52.12 Waterborne Disease Transmission	Form	Modified	Available
Form CDC 52.13 Foodborne Disease Transmission, Person-to-Person, Animal Contact	Form	Modified	Available
Form CDC 55.83B NREVSS Virus Isolation (culture) Worksheet	Form	Unchanged	Available
Form CDC 55.83D NREVSS Polymerase Chain Reaction (PCR) Worksheet	Form	Unchanged	Available
Form CDC 55.83A NREVSS Antigen Detection Worksheet	Form	Unchanged	Available
Form CDC 55.83 National Respiratory and Enteric Virus Surveillance System (NREVSS) Laboratory Assessment	Form	Unchanged	Available
Form CDC 55.90 Enterovirus Surveillance System Report Form	Form	Unchanged	Available
Non-substantive Change 0920-0004 Water_Foodborne_Flu 122014.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2014-12-18	Available
Att G_US Outpatient ILI Surv Network (ILINet) Weekly CDC 55.20.pdf	Supplementary Document	Uploaded 2014-08-18	Repair queued
SupSta A_0920-0004_REVISION.doc	Supporting Statement A	Uploaded 2014-07-25	Available
Att C_60d FRN (0920-0004).pdf	Supplementary Document	Uploaded 2014-07-25	Available
Att B_Disease Summaries.doc	Supplementary Document	Uploaded 2014-07-25	Available
Att A_Authorizing Legislation.pdf	Supplementary Document	Uploaded 2014-07-25	Available
SupSta B_0920-0004_REVISION.docx	Supporting Statement B	Uploaded 2014-07-25	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
37707	Att F US WHO Colloborating Laboratories Influenza Testing Methods Assessment	Form	Unchanged	US WHO Collaborating Laboratories Flu Testing Methods Assessment
212473	Att X Middle East Respiratory Syndrome Coronavirus (MERS) Patient Under Investigation (PUI) Form	Form	Unchanged	Middle East Respiratory Syndrome Coronavirus (MERS) Patient Under Investigation (PUI) Form
212472	Att W Adenovirus Typing Report Form	Form	Unchanged	Adenovirus Typing Report Form
212471	Att T Antiviral Resistant Influenza Infection Case Report Form	Form	Modified	Antiviral-Resistant Influenza Infection Case Report
212470	Att M Human Infections with Novel Influenza A Virus Severe Outcomes	Form	Unchanged	Human Infection with Novel Influenza A Virus Severe Outcomes
212469	Att L Human Infection with Novel Influenza A Virus with Suspected Avian Source	Form	Unchanged	Human Infection with Novel Influenza A Virus with Suspected Avian Source
199058	Att R_CMRS - City Health Officer or Vital Statistics Registrars Weekly Mortality Report	Form	Unchanged	122 CMRS-City Health Officers or Vital Statistics Registrars Weekly Mortality Report
199058	Att R_CMRS - City Health Officer or Vital Statistics Registrars Weekly Mortality Report	Form	Unchanged	CMRS Weekly
199057	Att Q_122 CMRS - City Health Officer or Vital Statistics Registrars Daily Mortality Report	Form	Unchanged	122 CMRS -City Health Officers or Vital Statistics Registrars Daily Mortality Report
199056	Att G US Outpatient Influenza-like Illness Surveillance Network (ILINet) Weekly	Form	Unchanged	US Outpatient Influenza-like Illness Surveillance Network (ILINet) Weekly
199054	Att I_ US Outpatient Influenza-like Illiness Surveillance Network (ILINet) Daily Reports	Form	Unchanged	US Outpatient Influenza like Illness Surveillance Network (ILINet) Daily Reports
199052	Att BB_ Influenza Virus Electronic year round PHIN-MS	Other-Variables for Reporting	Unchanged
199051	Att AA_ Influenza Virus Electronic year round - PHLIP_HL7 Messaging Data Elements	Other-Variables for Electronic Reporting	Unchanged
199050	Att J_Influenza Associated Pediatric Mortality Case Report Form	Form	Modified	Influenza-Associated Pediatric Mortality Case Report
199049	Att E_WHO Collaborating Center for Influenza Virus Surveillance Internet Year Round	Form	Unchanged	WHO Collaborating Center for Influenza Virus Surveillance (Internet: Year Round)
199045	Att S_Aggregate Hospitalization and Death Reporting Activity Weekly Report Form	Form	Unchanged	Aggregate Hospital
199043	Att K Human Infection with Novel Influenza A Virus Case Report Form	Form	Unchanged	Human Infection with Novel Influenza A Virus Case Report Form
199043	Att K Human Infection with Novel Influenza A Virus Case Report Form	Form	Unchanged	Human Infection with Novel Influenza A Virus Case Report Form
199042	Att N Novel Influenza A Virus Infection Contact Tracing Form	Form	Unchanged	Novel Influenza A Virus Infection Contact Tracing Form
199040	Att P Novel Influenza A Virus Case Screening Form	Form	Unchanged	Novel Influenza A Virus Case Screening Form
199039	Att O_Novel Influenza A Virus Status Case Status Summary	Form	Unchanged	Novel Influenza A Virus Case Status Summary
178374	Att Y_ Form for Submitting Specimens from Suspected Norovirus Outbreak	Form	Unchanged	Form for Submitting Specimens from Suspected Norovirus Outbreaks
178372	Att Z_ Waterborne Diseases Transmission	Form	Modified	Waterborne Disease Transmission
178369	Att D_Foodborne Disease Transmission Person-to-Person_Animal Contact	Form	Modified	Foodborne Disease Transmission, Person-to-Person, Animal Contact
178365	Att U_National Respiratory and Enteric Virus Surveillance System (NREVSS) Laboratory Assessment	Form	Unchanged	NREVSS Virus Isolation (culture) Worksheet
178365	Att U_National Respiratory and Enteric Virus Surveillance System (NREVSS) Laboratory Assessment	Form	Unchanged	NREVSS Polymerase Chain Reaction (PCR) Worksheet
178365	Att U_National Respiratory and Enteric Virus Surveillance System (NREVSS) Laboratory Assessment	Form	Unchanged	NREVSS Antigen Detection Worksheet
178365	Att U_National Respiratory and Enteric Virus Surveillance System (NREVSS) Laboratory Assessment	Form	Unchanged	National Respiratory and Enteric Virus Surveillance System (NREVSS) Laboratory Assessment
178364	Att V_ National Enterovirus Surveillance Report 55.9	Form	Unchanged	Enterovirus Surveillance System Report Form

ICR Details

OMB Control No: 0920-0004	ICR Reference No: 201412-0920-014
Status: Historical Active	Previous ICR Reference No: 201407-0920-012
Agency/Subagency: HHS/CDC	Agency Tracking No: 15IH
Title: National Disease Surveillance Program - II. Disease Summaries
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: 12/30/2014
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/23/2014
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2017	10/31/2017	10/31/2017
Responses	175,180	0	175,180
Time Burden (Hours)	31,921	0	31,921
Cost Burden (Dollars)	0	0	0

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Abstract: CDC requests approval for changes to 4 forms including adding, deleting, and reformatting some questions. There is no change in burden or respondents.

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Authorizing Statute(s): US Code: 42 USC 241 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
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 37	02/25/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 46828	08/11/2014
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 24

table that charts list of burden

IC Title	Form No.	Form Name
Att K Human Infection with Novel Influenza A Virus Case Report Form	none, None	Human Infection with Novel Influenza A Virus Case Report Form ,   Human Infection with Novel Influenza A Virus Case Report Form
Att AA_ Influenza Virus Electronic year round - PHLIP_HL7 Messaging Data Elements
Att BB_ Influenza Virus Electronic year round PHIN-MS
Att D_Foodborne Disease Transmission Person-to-Person_Animal Contact	CDC 52.13	Foodborne Disease Transmission, Person-to-Person, Animal Contact
Att E_WHO Collaborating Center for Influenza Virus Surveillance Internet Year Round	CDC 55.31	WHO Collaborating Center for Influenza Virus Surveillance (Internet: Year Round)
Att F US WHO Colloborating Laboratories Influenza Testing Methods Assessment	CDC 55.31A	US WHO Collaborating Laboratories Flu Testing Methods Assessment
Att G US Outpatient Influenza-like Illness Surveillance Network (ILINet) Weekly	CDC 55.20	US Outpatient Influenza-like Illness Surveillance Network (ILINet) Weekly
Att I_ US Outpatient Influenza-like Illiness Surveillance Network (ILINet) Daily Reports	None	US Outpatient Influenza like Illness Surveillance Network (ILINet) Daily Reports
Att J_Influenza Associated Pediatric Mortality Case Report Form	none	Influenza-Associated Pediatric Mortality Case Report
Att L Human Infection with Novel Influenza A Virus with Suspected Avian Source	None	Human Infection with Novel Influenza A Virus with Suspected Avian Source
Att M Human Infections with Novel Influenza A Virus Severe Outcomes	None	Human Infection with Novel Influenza A Virus Severe Outcomes
Att N Novel Influenza A Virus Infection Contact Tracing Form	None	Novel Influenza A Virus Infection Contact Tracing Form
Att O_Novel Influenza A Virus Status Case Status Summary	None	Novel Influenza A Virus Case Status Summary
Att P Novel Influenza A Virus Case Screening Form	None	Novel Influenza A Virus Case Screening Form
Att Q_122 CMRS - City Health Officer or Vital Statistics Registrars Daily Mortality Report	CDC 43.50	122 CMRS -City Health Officers or Vital Statistics Registrars Daily Mortality Report
Att R_CMRS - City Health Officer or Vital Statistics Registrars Weekly Mortality Report	CDC 43.5, none	CMRS Weekly ,   122 CMRS-City Health Officers or Vital Statistics Registrars Weekly Mortality Report
Att S_Aggregate Hospitalization and Death Reporting Activity Weekly Report Form	none	Aggregate Hospital
Att T Antiviral Resistant Influenza Infection Case Report Form	none	Antiviral-Resistant Influenza Infection Case Report
Att U_National Respiratory and Enteric Virus Surveillance System (NREVSS) Laboratory Assessment	CDC 55.83A, CDC 55.83D, CDC 55.83, CDC 55.83B	National Respiratory and Enteric Virus Surveillance System (NREVSS) Laboratory Assessment ,   NREVSS Antigen Detection Worksheet ,   NREVSS Polymerase Chain Reaction (PCR) Worksheet ,   NREVSS Virus Isolation (culture) Worksheet
Att V_ National Enterovirus Surveillance Report 55.9	CDC 55.90	Enterovirus Surveillance System Report Form
Att W Adenovirus Typing Report Form	None	Adenovirus Typing Report Form
Att X Middle East Respiratory Syndrome Coronavirus (MERS) Patient Under Investigation (PUI) Form	None	Middle East Respiratory Syndrome Coronavirus (MERS) Patient Under Investigation (PUI) Form
Att Y_ Form for Submitting Specimens from Suspected Norovirus Outbreak	None	Form for Submitting Specimens from Suspected Norovirus Outbreaks
Att Z_ Waterborne Diseases Transmission	CDC 52.12	Waterborne Disease Transmission

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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	175,180	175,180	0	0	0	0
Annual Time Burden (Hours)	31,921	31,921	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: $51,000

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: 12/23/2014

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