Information Collection

Influenza Surveillance (NCIRD)

IC 228601 under ICR 201611-0920-005 · OMB 0920-1158.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1158 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Influenza Surveillance (NCIRD)	Form and Instruction
NCIRD Influenza Surveillance Interview Protocol Guide an Interview Guide _NCIRD Influenza Surveillance_10232017.DOCX	Form and Instruction
Template_NCIRD Influenza Surveillance_10232017.DOCX I-Catalyst Template_NCIRD Influenza Surveillance	IC Document
ICatalyst SSA-NCIRD Influenza Surveillance_10232017.DOCX Supporting Statement A_NCIRD Influenza Surveillance	IC Document

IC Title:

Influenza Surveillance (NCIRD)

Agency IC Tracking Number:

0920-18AV

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	n/a	NCIRD Influenza Surveillance Interview Protocol Guide and Questions	Interview Guide _NCIRD Influenza Surveillance_10232017.DOCX		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	25	25
Annual IC Cost Burden (Dollars)	851	851

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
I-Catalyst Template_NCIRD Influenza Surveillance	Template_NCIRD Influenza Surveillance_10232017.DOCX	10/23/2017
Supporting Statement A_NCIRD Influenza Surveillance	ICatalyst SSA-NCIRD Influenza Surveillance_10232017.DOCX	10/23/2017

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