Information Collection

States - Reporting (Additional Laboratory Data Elements)

IC 209482 under ICR 201705-0920-011 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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
Att 5 - Laboratory Data_03172017.xlsx	Other- Added Data Elements (Laborato

IC Title:

States - Reporting (Additional Laboratory Data Elements)

Agency IC Tracking Number:

17AAC

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of 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
Other- Added Data Elements (Laboratory)	Att 5 - Laboratory Data_03172017.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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2,650	50	2,600
Annual IC Time Burden (Hours)	26,063	63	26,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.