National Disease Surveillance Program - II. Disease Summaries

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
WHO Collaborating Laboratories Influenza Testing Methods Assessment	Form	Modified	Available
Suspect Respiratory Virus Patient Form	Form	New	Repair queued
Form CDC 55.20E U.S. Outpatient Influenza-Like Illness Surveillance Network (ILINet) - Workfolder_CDC 55.20E	Form	New	Available
Middle East Respiratory Syndrome (MERS) Patient Under Investigation (PUI) Short Form	Form	Modified	Available
National Adenovirus Type Reporting System (NATRS) Form	Form	Modified	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	Removed	Available
Form CDC 43.5 122 CMRS-City Health Officers or Vital Statistics Registrars Weekly Mortality Report	Form	Removed	Available
CMRS Weekly	Form	Removed	Available
Form CDC 43.50 122 CMRS -City Health Officers or Vital Statistics Registrars Daily Mortality Report	Form	Removed	Available
Form CDC 55.20 US Outpatient Influenza-like Illness Surveillance Network (ILINet) Weekly	Form	Modified	Available
US Outpatient Influenza like Illness Surveillance Network (ILINet) Daily Reports	Form	Removed	Available
Influenza-Associated Pediatric Mortality Case Report	Form	Modified	Available
WHO Collaborating Center for Influenza Virus Surveillance	Form	Modified	Available
Aggregate Hospital	Form	Removed	Available
Human Infection with Novel Influenza A Virus Case Report Form (addition of Suspected Avian Source)	Form	Modified	Available
Novel Influenza A Virus Infection Contact Tracing Form	Form	Removed	Available
Novel Influenza A Virus Case Screening Form	Form	Modified	Available
Novel Influenza A Virus Case Status Summary	Form	Removed	Available
Viral Gastroenteritis Outbreak Submission Form	Form	Modified	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	Modified	Available
Form CDC 55.83D NREVSS Polymerase Chain Reaction (PCR) Worksheet	Form	Modified	Available
Form CDC 55.83A NREVSS Antigen Detection Worksheet	Form	Modified	Available
Form CDC 55.90 Enterovirus Surveillance System Report Form	Form	Modified	Available
Attachment DD_Human Subjects Determination 2017_0920-0004 Revision.pdf	Supplementary Document	Uploaded 2017-08-30	Available
Attachment C_Disease Summaries_Revision 2017_Final.doc	Supplementary Document	Uploaded 2017-08-30	Available
Attachment B_ 60 Day Federal Register Notice_0920_0004.pdf	Supplementary Document	Uploaded 2017-08-30	Available
Attachment A_Authorizing Legislation.pdf	Supplementary Document	Uploaded 2017-08-30	Available
0920-0004_Supporting Statement B_Revision 2017_Final.docx	Supporting Statement B	Uploaded 2017-08-30	Available
SSA 0920-0004 23AUG2017.docx	Supporting Statement A	Uploaded 2017-08-30	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

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
37707	Att F US WHO Colloborating Laboratories Influenza Testing Methods Assessment	Form	Modified	WHO Collaborating Laboratories Influenza Testing Methods Assessment
228082	Att. CC Suspect Respiratory Virus Patient Form	Form	New	Suspect Respiratory Virus Patient Form
228068	Att. H U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) Workfolder_CDC 55.20E	Form	New	U.S. Outpatient Influenza-Like Illness Surveillance Network (ILINet) - Workfolder_CDC 55.20E
212473	Att X Middle East Respiratory Syndrome Coronavirus (MERS) Patient Under Investigation (PUI) Form	Form	Modified	Middle East Respiratory Syndrome (MERS) Patient Under Investigation (PUI) Short Form
212472	Att W Adenovirus Typing Report Form	Form	Modified	National Adenovirus Type Reporting System (NATRS) Form
212471	Att T Antiviral Resistant Influenza Infection Case Report Form	Form	Unchanged	Antiviral-Resistant Influenza Infection Case Report
212470	Att M Human Infections with Novel Influenza A Virus Severe Outcomes	Form	Unchanged	Human Infection with Novel Influenza A Virus Severe Outcomes
212469	Att L Human Infection with Novel Influenza A Virus with Suspected Avian Source	Form	Removed	Human 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	Removed	122 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	Removed	CMRS Weekly
199057	Att Q_122 CMRS - City Health Officer or Vital Statistics Registrars Daily Mortality Report	Form	Removed	122 CMRS -City Health Officers or Vital Statistics Registrars Daily Mortality Report
199056	Att G US Outpatient Influenza-like Illness Surveillance Network (ILINet) Weekly	Form	Modified	US Outpatient Influenza-like Illness Surveillance Network (ILINet) Weekly
199054	Att I_ US Outpatient Influenza-like Illiness Surveillance Network (ILINet) Daily Reports	Form	Removed	US 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	Modified
199050	Att J_Influenza Associated Pediatric Mortality Case Report Form	Form	Modified	Influenza-Associated Pediatric Mortality Case Report
199049	Att E_WHO Collaborating Center for Influenza Virus Surveillance	Form	Modified	WHO Collaborating Center for Influenza Virus Surveillance
199045	Att S_Aggregate Hospitalization and Death Reporting Activity Weekly Report Form	Form	Removed	Aggregate Hospital
199043	Att K Human Infection with Novel Influenza A Virus Case Report Form	Form	Modified	Human Infection with Novel Influenza A Virus Case Report Form (addition of Suspected Avian Source)
199042	Att N Novel Influenza A Virus Infection Contact Tracing Form	Form	Removed	Novel Influenza A Virus Infection Contact Tracing Form
199040	Att P Novel Influenza A Virus Case Screening Form	Form	Modified	Novel Influenza A Virus Case Screening Form
199039	Att O_Novel Influenza A Virus Status Case Status Summary	Form	Removed	Novel Influenza A Virus Case Status Summary
178374	Att Y_ Viral Gastroenteritis Outbreak Submission Form	Form	Modified	Viral Gastroenteritis Outbreak Submission Form
178372	Att Z_ Waterborne Diseases Transmission	Form	Modified	NORS - Waterborne Disease Transmission
178369	Att D_NORS Foodborne Disease Transmission_ Person to Person Disease Transmission_Animal Contact_Environmental Contamination_Unknown Transmission Mode	Form	Modified	NORS - 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	Modified	NREVSS Virus Isolation (culture) Worksheet
178365	Att U_National Respiratory and Enteric Virus Surveillance System (NREVSS) Laboratory Assessment	Form	Modified	NREVSS Polymerase Chain Reaction (PCR) Worksheet
178365	Att U_National Respiratory and Enteric Virus Surveillance System (NREVSS) Laboratory Assessment	Form	Modified	NREVSS Antigen Detection Worksheet
178364	Att V_ National Enterovirus Surveillance Report 55.9	Form	Modified	Enterovirus Surveillance System Report Form

ICR Details

OMB Control No: 0920-0004	ICR Reference No: 201707-0920-010
Status: Historical Active	Previous ICR Reference No: 201612-0920-014
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-0004
Title: National Disease Surveillance Program - II. Disease Summaries
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/12/2017
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/31/2017
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2020	36 Months From Approved	10/31/2017
Responses	133,172	0	175,452
Time Burden (Hours)	24,801	0	32,012
Cost Burden (Dollars)	0	0	0

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Abstract: CDC requests approval for a Revision of 0920-0004 National Disease Surveillance Program - II. Disease Summaries. Revisions include addition of Forms, Discontinuation of Forms, and reformatting some questions. The overall result is a decrease in Burden Hours and Respondents.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act
  

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:
	82 FR 18459	04/19/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 41267	08/30/2017
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 19

table that charts list of burden

IC Title	Form No.	Form Name
Att K Human Infection with Novel Influenza A Virus Case Report Form	NA	Human Infection with Novel Influenza A Virus Case Report Form (addition of Suspected Avian Source)
Att AA_ Influenza Virus Electronic year round - PHLIP_HL7 Messaging Data Elements
Att BB_ Influenza Virus Electronic year round PHIN-MS
Att D_NORS Foodborne Disease Transmission_ Person to Person Disease Transmission_Animal Contact_Environmental Contamination_Unknown Transmission Mode	CDC 52.13	NORS - Foodborne, Person-to-Person, Animal Contact, Environmental Contamination, Unknown Transmission Mode
Att E_WHO Collaborating Center for Influenza Virus Surveillance	NA	WHO Collaborating Center for Influenza Virus Surveillance
Att F US WHO Colloborating Laboratories Influenza Testing Methods Assessment	NA	WHO Collaborating Laboratories Influenza Testing Methods Assessment
Att G US Outpatient Influenza-like Illness Surveillance Network (ILINet) Weekly	CDC 55.20	US Outpatient Influenza-like Illness Surveillance Network (ILINet) Weekly
Att I_ US Outpatient Influenza-like Illiness Surveillance Network (ILINet) Daily Reports	None	US Outpatient Influenza like Illness Surveillance Network (ILINet) Daily Reports
Att J_Influenza Associated Pediatric Mortality Case Report Form	NA	Influenza-Associated Pediatric Mortality Case Report
Att L Human Infection with Novel Influenza A Virus with Suspected Avian Source	None	Human Infection with Novel Influenza A Virus with Suspected Avian Source
Att M Human Infections with Novel Influenza A Virus Severe Outcomes	None	Human Infection with Novel Influenza A Virus Severe Outcomes
Att N Novel Influenza A Virus Infection Contact Tracing Form	None	Novel Influenza A Virus Infection Contact Tracing Form
Att O_Novel Influenza A Virus Status Case Status Summary	None	Novel Influenza A Virus Case Status Summary
Att P Novel Influenza A Virus Case Screening Form	None	Novel Influenza A Virus Case Screening Form
Att Q_122 CMRS - City Health Officer or Vital Statistics Registrars Daily Mortality Report	CDC 43.50	122 CMRS -City Health Officers or Vital Statistics Registrars Daily Mortality Report
Att R_CMRS - City Health Officer or Vital Statistics Registrars Weekly Mortality Report	CDC 43.5, none	CMRS Weekly ,   122 CMRS-City Health Officers or Vital Statistics Registrars Weekly Mortality Report
Att S_Aggregate Hospitalization and Death Reporting Activity Weekly Report Form	none	Aggregate Hospital
Att T Antiviral Resistant Influenza Infection Case Report Form	none	Antiviral-Resistant Influenza Infection Case Report
Att U_National Respiratory and Enteric Virus Surveillance System (NREVSS) Laboratory Assessment	CDC 55.83A, CDC 55.83D, CDC 55.83B	NREVSS Antigen Detection Worksheet ,   NREVSS Polymerase Chain Reaction (PCR) Worksheet ,   NREVSS Virus Isolation (culture) Worksheet
Att V_ National Enterovirus Surveillance Report 55.9	CDC 55.90	Enterovirus Surveillance System Report Form
Att W Adenovirus Typing Report Form	NA	National Adenovirus Type Reporting System (NATRS) Form
Att X Middle East Respiratory Syndrome Coronavirus (MERS) Patient Under Investigation (PUI) Form	None	Middle East Respiratory Syndrome (MERS) Patient Under Investigation (PUI) Short Form
Att Y_ Viral Gastroenteritis Outbreak Submission Form	None	Viral Gastroenteritis Outbreak Submission Form
Att Z_ Waterborne Diseases Transmission	CDC 52.12	NORS - Waterborne Disease Transmission
Att. CC Suspect Respiratory Virus Patient Form	NA	Suspect Respiratory Virus Patient Form
Att. H U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) Workfolder_CDC 55.20E	CDC 55.20E	U.S. Outpatient Influenza-Like Illness Surveillance Network (ILINet) - Workfolder_CDC 55.20E

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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	133,172	175,452	0	-42,280	0	0
Annual Time Burden (Hours)	24,801	32,012	0	-7,211	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: Yes

Burden Reduction Due to: Cutting Redundancy

Short Statement: Submission of 0920-0004 is a Revision containing both addition to and subtraction from current Burden Hours for individual collection instruments. Submission of this Revision results in an overall decrease in Burden Hours and Respondents.

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Annual Cost to Federal Government: $9,665,000

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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: 08/31/2017

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