Information Collection

Territories - Weekly, quarterly - non-automated

IC 228442 under ICR 201709-0920-004 · 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⚠️ Notice: This information collection may be referencing outdated material.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 - Core Data.xlsx Other-Data Elements
Att 6 - Laboratory Data.xlsx Other-Data Elements
Att 7 - Vaccine Data.xlsx Other-Data Elements
Att 8 - Vaccine Preventable Disease Data.xlsx Other-Data Elements
Att 10 - Disease-Specific Data.xlsx Other-Data Elements
Attachment 4 Core Data.xlsx Attachment 4 Core Data IC Document
Attachment 5 Disease-Specific Data.xlsx Attachment 5 Disease-Specific Data IC Document
Att 4 - Core Data.xlsx IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Territories - Weekly, quarterly - non-automated	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Data Elements	Att 5 - Core Data.xlsx	Yes	Yes	Fillable Fileable
Other-Data Elements	Att 6 - Laboratory Data.xlsx	Yes	Yes	Fillable Fileable
Other-Data Elements	Att 7 - Vaccine Data.xlsx	Yes	Yes	Fillable Fileable
Other-Data Elements	Att 8 - Vaccine Preventable Disease Data.xlsx	Yes	Yes	Fillable Fileable
Other-Data Elements	Att 10 - Disease-Specific Data.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: 5	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	280	280
Annual IC Time Burden (Hours)	93	93
Annual IC Cost Burden (Dollars)	3,489	3,489

Documents for IC

Title	Document	Date Uploaded
Attachment 4 Core Data	Attachment 4 Core Data.xlsx	11/13/2013
Attachment 5 Disease-Specific Data	Attachment 5 Disease-Specific Data.xlsx	11/13/2013
	Att 4 - Core Data.xlsx	09/21/2015

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.