Acute Respiratory Infection and Influenza Surveillance Form

Information Collection on Cause-Specific Absenteeism in Schools

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1039 can be found here:

Documents and Forms

Document Name Document Type
Acute Respiratory Infection and Influenza Surveillance Form Form
Acute Respiratory Infection and Influenza Surveillance F Orchards ari surveillance form revised 12 22 15_1-temte.docx Form

Information Collection (IC) Details

IC Title:	Acute Respiratory Infection and Influenza Surveillance Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	NA	Acute Respiratory Infection and Influenza Surveillance Form 28DEC2015	Orchards ari surveillance form revised 12 22 15_1-temte.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0160 Records of Subjects in Health Promotion and Education Studies, HHS/CDC.CHPE	FR Citation: 51 FR 42484

Number of Respondents: 1,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	6,000	6,000
Annual IC Time Burden (Hours)	3,000	3,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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