OMB Control No: 0920-1011
ICR Reference No:
201501-0920-020
Status: Historical Inactive
Previous ICR Reference No: 201410-0920-034
Agency/Subagency: HHS/CDC
Agency Tracking No: 20989 15LX
Title: Emergency Epidemic
Investigation Data Collections - Expedited Reviews
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: Improperly
submitted and continue
Conclusion Date: 02/12/2015
Retrieve
Notice of Action (NOA)
Date Received in OIRA:
01/27/2015
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
03/31/2017
03/31/2017
03/31/2017
Responses
36,000
0
36,000
Time Burden (Hours)
18,000
0
18,000
Cost Burden (Dollars)
0
0
0
Abstract: CDC submits the quarterly inventory of
forms and burden memos per agreement with OMB.
Authorizing Statute(s): US Code:
42
USC 301 Name of Law: PHSA
Citations for New Statutory
Requirements: None
Associated Rulemaking
Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices &
Comments
60-day Notice:
Federal Register Citation:
Citation Date:
78 FR
41930
07/12/2013
30-day Notice:
Federal Register Citation:
Citation Date:
78 FR
69854
11/21/2013
Did the Agency receive public comments on
this ICR?
Yes
Number of Information Collection (IC) in this
ICR: 22
IC Title
Form No.
Form Name
Dengue_AZ
CDC56.31A
DENGUE Case Investigation
Report
2014009-XXX_Chikungunya_US Service
Org Volunteers
Pediatric cluster of
neurologic symptoms - Colorado
none, none
Family Interview
Questionnaire , Medical Chart
Abstraction
CCRF_Georgia
none, none, none
Case
Investigation , KAP Survey ,
Consent
Chikungunya_USVI
CDC 56.31 A REV. 06/2006
Dengue Case Investigation
Report
Pseudomonas
NICU_CA
Ebola_TX
None, None
Appendix 1 - Ebola
Case Investigation Form , Appendix 2 - Ebola Case Contact
Questionnaire
2014E003XXX_MERS-CoV_GA
none, none
Questionnaire for
Passengers and Crew , Follow-up Questionnaire for
Asymptomatic Passengers and Crew
2014012-XXX Resp
Illness UC_CA
2014010-XXX
Ebola_Guinea
0920-1011, 0920-1011
Appendix 1- Case
Investigation Form , Appendix 2- Contact Tracing
Form
20140006XXX Measles
FSM
2014011-XXX
Ebola_Liberia
none, none
Case Report
Form , Contact Listing Form
2014015-XXX_Parechovirus_Multi
none, none
Chart
Abstraction , Family interview
2014014-XXX
Ebola_Sierra Leone
2014004XXX_Legionnaires'
Disease_Alabama 2014
none, none
Record
Abstraction , Interview
Questionnaire
Mucormycosis_Kansas
None, None
Infection
Prevention and Control Questions for Investigation of
Mucormycosis , Mucormycosis Data Abstraction
Form
Ebola_West
Africa_2014
none, none, none
Observation
Guide , Field Guide ,
Focus Group
Guide
BSI_CA
none, none, none
Chart
Abstraction , Outpatient Dialysis Practices
Survey , Reprocessing Observation
Checklist
2014013-XXX_Resp
Illness UAC_Multi
2014016-XXX_Ebola_DRC
2014005XXX_DiarrhealDisease_AS
none, none
Medical Abstraction
Form , Case
Questionnaire
2014008-XXX
Chikungunya_PR
none, none, none, none
Household
Questionnaire , Individual Questionnaire ,
Case Report
(English) , Case Report (Spanish)
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: This is a new generic
information collection request.
Annual Cost to Federal Government:
$1,510,099
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
Agency Contact: Shari Steinberg 404 639-4942
[email protected]