OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

ICR 201612-0920-014 · OMB 0920-0004 · Public filing

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CDC 55.31A US WHO Collaborating Laboratories Flu Testing Methods Assessment Form Unchanged Available
Middle East Respiratory Syndrome Coronavirus (MERS) Patient Under Investigation (PUI) Form Form Unchanged Available
Adenovirus Typing Report Form Form Unchanged Available
Antiviral-Resistant Influenza Infection Case Report Form Unchanged Available
Human Infection with Novel Influenza A Virus Severe Outcomes Form Unchanged Available
Human Infection with Novel Influenza A Virus with Suspected Avian Source Form Unchanged Available
Form CDC 43.5 122 CMRS-City Health Officers or Vital Statistics Registrars Weekly Mortality Report Form Unchanged Available
CMRS Weekly Form Unchanged Available
Form CDC 43.50 122 CMRS -City Health Officers or Vital Statistics Registrars Daily Mortality Report Form Unchanged Available
Form CDC 55.20 US Outpatient Influenza-like Illness Surveillance Network (ILINet) Weekly Form Unchanged Available
US Outpatient Influenza like Illness Surveillance Network (ILINet) Daily Reports Form Unchanged Available
Influenza-Associated Pediatric Mortality Case Report Form Unchanged Available
Form CDC 55.31 WHO Collaborating Center for Influenza Virus Surveillance (Internet: Year Round) Form Unchanged Available
Aggregate Hospital Form Unchanged Available
Human Infection with Novel Influenza A Virus Case Report Form Form Unchanged Available
Human Infection with Novel Influenza A Virus Case Report Form Form Unchanged Available
Novel Influenza A Virus Infection Contact Tracing Form Form Unchanged Available
Novel Influenza A Virus Case Screening Form Form Unchanged Available
Novel Influenza A Virus Case Status Summary Form Unchanged Available
Form for Submitting Specimens from Suspected Norovirus Outbreaks Form Unchanged Available
Form CDC 52.12 NORS - Waterborne Disease Transmission Form Modified Available
Form CDC 52.13 NORS - Foodborne, Person-to-Person, Animal Contact, Environmental Contamination, Unknown Transmission Mode Form Modified Available
Form CDC 55.83B NREVSS Virus Isolation (culture) Worksheet Form Unchanged Available
Form CDC 55.83D NREVSS Polymerase Chain Reaction (PCR) Worksheet Form Unchanged Available
Form CDC 55.83A NREVSS Antigen Detection Worksheet Form Unchanged Available
Form CDC 55.83 National Respiratory and Enteric Virus Surveillance System (NREVSS) Laboratory Assessment Form Unchanged Available
Form CDC 55.90 Enterovirus Surveillance System Report Form Form Unchanged Available
Change Request 0920-0004_FINAL_clean3.docx Justification for No Material/Nonsubstantive Change Uploaded 2016-12-23 Available
Non-substantive Change 0920-0004 Water_Foodborne_Flu 122014.docx Justification for No Material/Nonsubstantive Change Uploaded 2014-12-18 Available
Att G_US Outpatient ILI Surv Network (ILINet) Weekly CDC 55.20.pdf Supplementary Document Uploaded 2014-08-18 Available
SupSta A_0920-0004_REVISION.doc Supporting Statement A Uploaded 2014-07-25 Available
Att C_60d FRN (0920-0004).pdf Supplementary Document Uploaded 2014-07-25 Available
Att B_Disease Summaries.doc Supplementary Document Uploaded 2014-07-25 Available
Att A_Authorizing Legislation.pdf Supplementary Document Uploaded 2014-07-25 Available
SupSta B_0920-0004_REVISION.docx Supporting Statement B Uploaded 2014-07-25 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
37707 Att F US WHO Colloborating Laboratories Influenza Testing Methods Assessment Form UnchangedUS WHO Collaborating Laboratories Flu Testing Methods Assessment
212473 Att X Middle East Respiratory Syndrome Coronavirus (MERS) Patient Under Investigation (PUI) Form Form UnchangedMiddle East Respiratory Syndrome Coronavirus (MERS) Patient Under Investigation (PUI) Form
212472 Att W Adenovirus Typing Report Form Form UnchangedAdenovirus Typing Report Form
212471 Att T Antiviral Resistant Influenza Infection Case Report Form Form UnchangedAntiviral-Resistant Influenza Infection Case Report
212470 Att M Human Infections with Novel Influenza A Virus Severe Outcomes Form UnchangedHuman Infection with Novel Influenza A Virus Severe Outcomes
212469 Att L Human Infection with Novel Influenza A Virus with Suspected Avian Source Form UnchangedHuman Infection with Novel Influenza A Virus with Suspected Avian Source
199058 Att R_CMRS - City Health Officer or Vital Statistics Registrars Weekly Mortality Report Form Unchanged122 CMRS-City Health Officers or Vital Statistics Registrars Weekly Mortality Report
199058 Att R_CMRS - City Health Officer or Vital Statistics Registrars Weekly Mortality Report Form UnchangedCMRS Weekly
199057 Att Q_122 CMRS - City Health Officer or Vital Statistics Registrars Daily Mortality Report Form Unchanged122 CMRS -City Health Officers or Vital Statistics Registrars Daily Mortality Report
199056 Att G US Outpatient Influenza-like Illness Surveillance Network (ILINet) Weekly Form UnchangedUS Outpatient Influenza-like Illness Surveillance Network (ILINet) Weekly
199054 Att I_ US Outpatient Influenza-like Illiness Surveillance Network (ILINet) Daily Reports Form UnchangedUS Outpatient Influenza like Illness Surveillance Network (ILINet) Daily Reports
199052 Att BB_ Influenza Virus Electronic year round PHIN-MS Other-Variables for Reporting Unchanged
199051 Att AA_ Influenza Virus Electronic year round - PHLIP_HL7 Messaging Data Elements Other-Variables for Electronic Reporting Unchanged
199050 Att J_Influenza Associated Pediatric Mortality Case Report Form Form UnchangedInfluenza-Associated Pediatric Mortality Case Report
199049 Att E_WHO Collaborating Center for Influenza Virus Surveillance Internet Year Round Form UnchangedWHO Collaborating Center for Influenza Virus Surveillance (Internet: Year Round)
199045 Att S_Aggregate Hospitalization and Death Reporting Activity Weekly Report Form Form UnchangedAggregate Hospital
199043 Att K Human Infection with Novel Influenza A Virus Case Report Form Form UnchangedHuman Infection with Novel Influenza A Virus Case Report Form
199043 Att K Human Infection with Novel Influenza A Virus Case Report Form Form UnchangedHuman Infection with Novel Influenza A Virus Case Report Form
199042 Att N Novel Influenza A Virus Infection Contact Tracing Form Form UnchangedNovel Influenza A Virus Infection Contact Tracing Form
199040 Att P Novel Influenza A Virus Case Screening Form Form UnchangedNovel Influenza A Virus Case Screening Form
199039 Att O_Novel Influenza A Virus Status Case Status Summary Form UnchangedNovel Influenza A Virus Case Status Summary
178374 Att Y_ Form for Submitting Specimens from Suspected Norovirus Outbreak Form UnchangedForm for Submitting Specimens from Suspected Norovirus Outbreaks
178372 Att Z_ Waterborne Diseases Transmission Form ModifiedNORS - Waterborne Disease Transmission
178369 Att D_Foodborne Disease Transmission Person-to-Person_Animal Contact Form ModifiedNORS - Foodborne, Person-to-Person, Animal Contact, Environmental Contamination, Unknown Transmission Mode
178365 Att U_National Respiratory and Enteric Virus Surveillance System (NREVSS) Laboratory Assessment Form UnchangedNREVSS Virus Isolation (culture) Worksheet
178365 Att U_National Respiratory and Enteric Virus Surveillance System (NREVSS) Laboratory Assessment Form UnchangedNREVSS Polymerase Chain Reaction (PCR) Worksheet
178365 Att U_National Respiratory and Enteric Virus Surveillance System (NREVSS) Laboratory Assessment Form UnchangedNREVSS Antigen Detection Worksheet
178365 Att U_National Respiratory and Enteric Virus Surveillance System (NREVSS) Laboratory Assessment Form UnchangedNational Respiratory and Enteric Virus Surveillance System (NREVSS) Laboratory Assessment
178364 Att V_ National Enterovirus Surveillance Report 55.9 Form UnchangedEnterovirus Surveillance System Report Form

ICR Details

Record metadata
OMB Control No0920-0004