Emergency Epidemic Investigation Data Collections - Expedited Reviews

ICR 201601-0920-017

OMB: 0920-1011

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
New
Form and Instruction
New
Form and Instruction
New
Form and Instruction
New
Form and Instruction
New
Form and Instruction
New
Form and Instruction
New
Form and Instruction
New
Form
Unchanged
Form
Unchanged
Form and Instruction
Unchanged
Form and Instruction
Unchanged
Form
Unchanged
Form and Instruction
Unchanged
Form and Instruction
Unchanged
Form
Unchanged
Form and Instruction
Unchanged
Form and Instruction
Unchanged
Form and Instruction
Unchanged
Form
Unchanged
Form
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Form and Instruction
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Form and Instruction
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Form
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Supplementary Document
2016-01-27
Supplementary Document
2016-01-27
Supplementary Document
2016-01-27
Supplementary Document
2015-11-03
Supplementary Document
2015-11-03
Supplementary Document
2015-11-03
Supplementary Document
2015-07-07
Supplementary Document
2015-07-07
Supplementary Document
2015-07-07
Supplementary Document
2015-04-22
Supplementary Document
2015-04-22
Justification for No Material/Nonsubstantive Change
2015-04-22
Justification for No Material/Nonsubstantive Change
2015-03-03
Supplementary Document
2015-03-03
Supplementary Document
2015-03-03
Supplementary Document
2014-10-29
Supplementary Document
2014-10-29
Supplementary Document
2014-10-29
Supplementary Document
2014-10-29
Supplementary Document
2014-10-29
Supplementary Document
2014-10-29
Supplementary Document
2014-10-29
Supplementary Document
2014-10-29
Supplementary Document
2014-10-29
Supplementary Document
2014-10-29
Supplementary Document
2014-10-29
Supplementary Document
2014-10-29
Justification for No Material/Nonsubstantive Change
2014-10-29
Supporting Statement B
2014-03-25
Supplementary Document
2013-11-20
Supplementary Document
2013-11-20
Supplementary Document
2013-11-20
Supplementary Document
2013-11-20
Supplementary Document
2013-11-20
Supplementary Document
2013-11-20
Supplementary Document
2013-11-20
Supplementary Document
2013-11-20
Supplementary Document
2013-11-20
Supplementary Document
2014-03-25
Supplementary Document
2014-03-25
Supplementary Document
2014-03-25
Supplementary Document
2013-11-20
Supplementary Document
2013-11-20
Supporting Statement A
2014-03-25
IC Document Collections
IC ID
Document
Title
Status
220946 New
220781 New
220762 New
220680 New
220097 New
220062 New
220061 New
220060 New
219577 Unchanged
219234 Unchanged
219193 Unchanged
218903 Unchanged
218858 Unchanged
218802 Unchanged
217928 Unchanged
217651 Unchanged
217021 Unchanged
214996 Unchanged
214724 Unchanged
214409 Unchanged
214244 Unchanged
213373 Unchanged
213323 Unchanged
213274 Unchanged
213233 Unchanged
213189 Unchanged
213101 Unchanged
212908 Unchanged
212644 Unchanged
212395 Unchanged
212348 Unchanged
212320 Unchanged
212266 Unchanged
212227
Unchanged
212127 Unchanged
211951 Unchanged
211894 Unchanged
211760 Unchanged
211705 Unchanged
211702 Unchanged
211682 Unchanged
ICR Details
0920-1011 201601-0920-017
Historical Active 201511-0920-002
HHS/CDC 16LW
Emergency Epidemic Investigation Data Collections - Expedited Reviews
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 01/27/2016
Retrieve Notice of Action (NOA) 01/27/2016
  Inventory as of this Action Requested Previously Approved
03/31/2017 03/31/2017 03/31/2017
36,000 0 36,000
18,000 0 18,000
0 0 0

CDC submits the quarterly inventory of forms and burden memos per agreement with OMB.

US Code: 42 USC 301 Name of Law: PHSA
  
None

Not associated with rulemaking

  78 FR 41930 07/12/2013
78 FR 69854 11/21/2013
Yes

41
IC Title Form No. Form Name
Undetermined Source of an outbreak of Legionnaires' Disease among Hotel A Visitors - Hannibal, MO 2015 NA, NA Legionella Environmental Assessment Form ,   Sample Data Sheet
Tainted Beverage_Mozambique
CCRF_Georgia none, none, none Case Investigation ,   KAP Survey ,   Consent
Chikungunya_USVI CDC 56.31 A REV. 06/2006 Dengue Case Investigation Report
2014008-XXX Chikungunya_PR none, none, none, none Household Questionnaire ,   Individual Questionnaire ,   Case Report (English) ,   Case Report (Spanish)
Pseudomonas NICU_CA
2014014-XXX Ebola_Sierra Leone
Undetermined risk of exposure for human-to-human spread of rabies to contact of case patient following mongoose-associated human rabies case, Puerto Rico, 2015. NA, NA, NA, NA Community Assessment ,   Community Assessment - Spanish ,   Healthcare Worker Assessment ,   Healthcare Worker Assessment
Ebola_West Africa_2014 none, none, none Observation Guide ,   Field Guide ,   Focus Group Guide
2014E003XXX_MERS-CoV_GA none, none Questionnaire for Passengers and Crew ,   Follow-up Questionnaire for Asymptomatic Passengers and Crew
2014004XXX_Legionnaires' Disease_Alabama 2014 none, none Record Abstraction ,   Interview Questionnaire
2014013-XXX_Resp Illness UAC_Multi
Undetermined sources, modes of transmission, risk factors, and health outcomes for Zika virus infection - Brazil, 2016 NA, NA Survey Questionnaire ,   Chart Abstraction
GAS_IL 2015 NA, NA GAS_IL Medical Record Abstraction ,   GAS_IL Employee Questionnaire
2014010-XXX Ebola_Guinea 0920-1011, 0920-1011 Appendix 1- Case Investigation Form ,   Appendix 2- Contact Tracing Form
2014009-XXX_Chikungunya_US Service Org Volunteers
Mucormycosis_Kansas None, None Infection Prevention and Control Questions for Investigation of Mucormycosis ,   Mucormycosis Data Abstraction Form
Qualitative Investigation of HIV Transmission in Southeastern Indiana, 2015 NA HIV Risk Factors Interview Guide
Undetermined sources, modes of transmission, risk factors, and health outcomes for Zika virus infection - Puerto Rico, 2016 NA, NA Zika Virus Disease Case Investigation Form ,   2016 Urgent Assessment of Blood Collection and Use in Puerto Rico in Response to the Zika Virus Outbreak
Pediatric cluster of neurologic symptoms - Colorado none, none Medical Chart Abstraction ,   Family Interview Questionnaire
Dengue_AZ CDC56.31A DENGUE Case Investigation Report
2014005XXX_DiarrhealDisease_AS none, none Medical Abstraction Form ,   Case Questionnaire
2014011-XXX Ebola_Liberia none, none Case Report Form ,   Contact Listing Form
Cholera_Kenya None, None Community Questionnaire ,   Healthcare Worker Questionnaire
Undetermined risk factors for ocular syphilis - North Carolina, 2015 NA, NA Abstraction Form ,   Interview Form
Undetermined source, mode of transmission, and risk factors for an outbreak of group A Streptococcus among residents of a long term care facility - Chicago, Illinois, 2016 NA, NA, NA Invasive GAS in LTCF 2016 - Employee Survey ,   Investigation of GAS outbreak in LTCF 2016 - Resident Record Extraction Form ,   Invasive GAS in Long Term Care Facility 2016 - Wound Care Survey
Undetermined sources and risk factors for a Rift Valley Fever Outbreak-Uganda, 2016 NA, NA Risk Factor Questionnaire ,   Livestock Assessment Form
Undetermined risk factors for E.coli O157 among visitors to a goat dairy--Connecticut, 2016 NA Festival A Interview Form
2014015-XXX_Parechovirus_Multi none, none Chart Abstraction ,   Family interview
BSI_CA none, none, none Chart Abstraction ,   Outpatient Dialysis Practices Survey ,   Reprocessing Observation Checklist
Burkholderia Investigation_LA None Risk Assessment for Primate Research Center Employees and Inspectors
Undetermined agent, source, mode of transmission, and risk factors for Guillain-Barré Syndrome in the setting of Zika virus transmission - Colombia, 2016 NA, NA, NA, NA GBS_Columbia Case Control Investigation Questionnaire - English ,   GBS_Columbia Case Control Investigation Questionnaire - Spanish ,   GBS_Columbia Chart Abstraction Form - English ,   GBS_Columbia Chart Abstraction Form - Spanish
20140006XXX Measles FSM
2014016-XXX_Ebola_DRC
Undetermined sources, modes of transmission, risk factors, and health outcomes for Zika virus infection – American Samoa, 2016 NA Zika Virus Disease Case Investigation Form
Undetermined source of Elizabethkingia meningoseptica bloodstream infection among Wisconsin residents - Wisconsin, 2016 NA Elizabethkingia Meningoseptica Case Investigation Form
Ebola_TX None, None Appendix 1 - Ebola Case Investigation Form ,   Appendix 2 - Ebola Case Contact Questionnaire
Undetermined risk factors associated with increase in bites from rabid dogs, resulting in at least one human death, Gonaives, Haiti, 2015 NA, NA, NA, NA, NA, NA, NA, NA Medical Providers Interview Survey - French ,   Rabies Official Interview Survey - English ,   Rabies Official Interview Survey - French ,   Public Health Official Interview Survey - English ,   Public Health Official Interview Survey - French ,   Community Suyrvey - English ,   Community Survey - French ,   Medical Providers Interview Survey - English
PA NTM none, none Interview Questions ,   Records Abstraction Information
EEI Guillain-Barre Syndrome_Bahia Brazil NA, NA, NA, NA Case Control Questionnaire - GBS English ,   Case Control Questionnaire - GBS Portugese ,   Chart Abstraction Questionnaire - GBS English ,   Chart Abstraction Questionnaire - GBS Portugese
2014012-XXX Resp Illness UC_CA

  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 36,000 36,000 0 0 0 0
Annual Time Burden (Hours) 18,000 18,000 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
This is a new generic information collection request.

$1,510,099
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Catina Conner 404 639-4775

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
01/27/2016


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