Data Sharing Permissions

National Syndromic Surveillance Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0824 can be found here:

Documents and Forms

Document Name Document Type
Data Sharing Permissions Form
Data Sharing Permissions Att 7 - BioSense Data Sharing Screen Shot.pdf Form
Att 3 - Healthcare Data Elements.pdf Healthcare Data Elements IC Document

Information Collection (IC) Details

IC Title:	Data Sharing Permissions	Agency IC Tracking Number:

Is this a Common Form? No		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	none	Data Sharing Permissions	Att 7 - BioSense Data Sharing Screen Shot.pdf		Yes	Yes	Fillable Fileable

Line of Business: Disaster Management

Subfunction: Emergency Response

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20	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	20	20
Annual IC Time Burden (Hours)	13	13
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Healthcare Data Elements	Att 3 - Healthcare Data Elements.pdf	05/11/2016

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