Enhanced Surveillance of Coccidioidomycosis in Low- and Non-Endemic States

Forms and Documents

Document Name	Status
Case Report Form for Coccidioidomycosis Form	New
Attachment 3 cocci surveillance non-research determination.pdf Supplementary Document	2015-05-20
Attach 2 60 day notice.pdf Supplementary Document	2015-05-20
Attach 1_Authorizing_Regulations_T42_section_241.doc Supplementary Document	2015-05-20
ICR Statement B cocci enhanced surveillance 5.7.15.docx Supporting Statement B	2015-05-20
ICR Statement A cocci enhanced surveillance 5.7.15.docx Supporting Statement A	2015-05-20

IC Document Collections

IC ID	Document Title	Status
216654	Case Report Form for Coccidioidomycosis Form	New

ICR Details

OMB Control No: 0920-1087	ICR Reference No: 201505-0920-006
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 15UR
Title: Enhanced Surveillance of Coccidioidomycosis in Low- and Non-Endemic States
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/19/2015
	Date Received in OIRA: 06/08/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2017	24 Months From Approved
Responses	145	0	0
Time Burden (Hours)	48	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Coccidioidomycosis, also called Valley Fever, is a nationally notifiable fungal infection caused by inhalation of soil-dwelling Coccidioides spp. arthroconidia. The goal is to better describe the epidemiological and clinical characteristics of cases in low and non-endemic states. For one year, state health department personnel will conduct phone interviews with reported cases.

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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:
	80 FR 1639	03/27/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 31379	06/02/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Case Report Form for Coccidioidomycosis	none	Case Report for Coccidioidomycosis

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ICR Summary 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	145	0	0	145	0	0
Annual Time Burden (Hours)	48	0	0	48	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new ICR.

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Annual Cost to Federal Government: $11,728

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: 06/08/2015

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