Canine Leptospirosis Surveillance in Puerto Rico

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Case Questionnaire - Dog Owner	Form	New	Available
Case Questionnaire - Veterinarian	Form	New	Available
Log Sheet	Form	New	Available
Enrollment Questionnaire for Clinics and Shelter	Form	New	Available
Att F--Owner_Consent_Form_2017_1_5_Spanish_aa.doc	Supplementary Document	Uploaded 2017-01-05	Available
Att F--Owner_Consent_Form_2016_9_22 lepto PR.aa.doc	Supplementary Document	Uploaded 2017-01-05	Available
Att. G--IACUC Exemption.pdf	Supplementary Document	Uploaded 2017-01-05	Available
Att B - Published FRN.pdf	Supplementary Document	Uploaded 2017-01-05	Available
Att A - Section 301 of the Public Health Service Act (42 USC 241).pdf	Supplementary Document	Uploaded 2017-01-05	Available
Supporting Statement B_1_4_17 CLEAN.docx	Supporting Statement B	Uploaded 2017-01-05	Available
Supporting Statement A_1_4_17 CLEAN.docx	Supporting Statement A	Uploaded 2017-01-05	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
225039	Case Questionnaire - Dog Owner	Form	New
225038	Case Questionnaire - Veterinarian	Form	New
225036	Log Sheet	Form	New
225035	Enrollment Questionnaire for Clinics and Shelter	Form	New

ICR Details

OMB Control No: 0920-1170	ICR Reference No: 201701-0920-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 16BGH
Title: Canine Leptospirosis Surveillance in Puerto Rico
Type of Information Collection: Existing collection in use without an OMB Control Number	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/15/2017
	Date Received in OIRA: 01/13/2017
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2019	24 Months From Approved
Responses	1,898	0	0
Time Burden (Hours)	168	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The goals of the data collection are to characterize the epidemiology of canine leptospirosis in Puerto Rico, assess the applicability of canine Leptospira vaccines used in the island, and determine potential rodent, livestock, and wildlife reservoirs for leptospirosis. Findings will be used to develop recommendations for the prevention of leptospirosis in dogs, focus human surveillance efforts, and guide further investigations.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: PHSA
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 70684	10/13/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 4339	01/13/2017
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Case Questionnaire - Veterinarian	none, none	Case Questionnaire ,   Case Questionnaire - Spanish
Case Questionnaire - Dog Owner	none, none	Case Questionnaire - Dog Owner ,   Case Questionnaire for Dog Owner - Spanish
Enrollment Questionnaire for Clinics and Shelter	none, none	Enrollment Questionnaire - Spanish ,   Enrollment Questionnaire
Log Sheet	none, none	Log Sheet ,   Log Sheet - Spanish

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ICR Summary of Burden

table that charts list of burden

	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	1,898	0	0	1,898	0	0
Annual Time Burden (Hours)	168	0	0	168	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is an existing collection without an OMB number.

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Annual Cost to Federal Government: $81,293

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 01/13/2017

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