Information Collection

States - Reporting

IC 209482 under ICR 201501-0920-001 · OMB 0920-0728.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0728 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment 4 Core Data.xlsx	Other-Data Elements
Attachment 5 Disease-Specific Data.xlsx	Other-Data Elements
Attachment 5 Disease-Specific Data_12182014.xlsx	Other-XCEL
OMB 0920-0728 change request_arboviral 12192014.doc Change Request Justification	IC Document

IC Title:

States - Reporting

Agency IC Tracking Number:

15IT

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Data Elements	Attachment 4 Core Data.xlsx	Yes	Yes	Fillable Fileable
Other-Data Elements	Attachment 5 Disease-Specific Data.xlsx	Yes	Yes	Fillable Fileable
Other-XCEL	Attachment 5 Disease-Specific Data_12182014.xlsx	Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title: 09-20-0136 Epidemiologic Studies and Surveillance of Disease Problems

FR Citation: 57 FR 6812

Number of Respondents: 50

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	Previously Approved
Annual Number of Responses for this IC	2,600	2,600
Annual IC Time Burden (Hours)	26,000	26,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Change Request Justification	OMB 0920-0728 change request_arboviral 12192014.doc	01/05/2015

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