Information Collection

States - Reporting

IC 209482 under ICR 201702-0920-014 · OMB 0920-0728.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0728 can be found here:

Documents and Forms

Document Name Document Type
Att 5 - Laboratory Data.xlsx Other-Data elements
Att 6 - Vaccine Data_04192016.xlsx Other-Data elements
Att 7 - Disease Specific Data_varicella_04192016.xlsx Other-Data Elements
Att 7 - Disease Specific Data_HPS 06012016.xlsx Other-Data Elements
Att 4 - Core Data_occupation_08152016.xlsx Other-Data Elements
Att 7 - Disease Specific Data_IPD_11152016.xlsx Other-Data elements
Att 7 - Disease Specific Data_Vibriosis_12012016.xlsx Other-New Vibriosis Data Elements
Att 7 - Disease Specific Data_Cyclosporiasis_12132016.xlsx Other-New Cyclosporiasis Data Elemen
Att 7 - Disease Specific Data_Trichinellosis_12162016.xlsx Other-New Trichinellosis Data Elemen
Att 7 - Disease Specific Data_STD_02162017.xlsx Other-New: Syphilis Data Elements

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	States - Reporting	Agency IC Tracking Number:	17TZ

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Data elements	Att 5 - Laboratory Data.xlsx		Yes	Yes	Fillable Fileable
Other-Data elements	Att 6 - Vaccine Data_04192016.xlsx		Yes	Yes	Fillable Fileable
Other-Data Elements	Att 7 - Disease Specific Data_varicella_04192016.xlsx		Yes	Yes	Fillable Fileable
Other-Data Elements	Att 7 - Disease Specific Data_HPS 06012016.xlsx		Yes	Yes	Fillable Fileable
Other-Data Elements	Att 4 - Core Data_occupation_08152016.xlsx	NA	Yes	Yes	Fillable Fileable
Other-Data elements	Att 7 - Disease Specific Data_IPD_11152016.xlsx		Yes	Yes	Fillable Fileable
Other-New Vibriosis Data Elements	Att 7 - Disease Specific Data_Vibriosis_12012016.xlsx		Yes	Yes	Fillable Fileable
Other-New Cyclosporiasis Data Elements	Att 7 - Disease Specific Data_Cyclosporiasis_12132016.xlsx		Yes	Yes	Fillable Fileable
Other-New Trichinellosis Data Elements	Att 7 - Disease Specific Data_Trichinellosis_12162016.xlsx	NA	Yes	Yes	Fillable Fileable
Other-New: Syphilis Data Elements	Att 7 - Disease Specific Data_STD_02162017.xlsx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 76 FR 4458

Number of Respondents: 50	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	2,600	2,600
Annual IC Time Burden (Hours)	26,000	26,000
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.