Information Collection

Parents - Acute Respiratory Infection and Influenza Surveillance Form

IC 212417 under ICR 201710-0920-016 · OMB 0920-1039.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1039 can be found here:

Documents and Forms

Document Name Document Type
Parents - Acute Respiratory Infection and Influenza Surveillance Form Form
Acute Respiratory Infection and Influenza Surveillance F Att. C4 - Acute Respiratory Infection and Influenza Surveillance Form.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Parents - Acute Respiratory Infection and Influenza Surveillance Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	NA	Acute Respiratory Infection and Influenza Surveillance Form	Att. C4 - Acute Respiratory Infection and Influenza Surveillance Form.docx	NA	No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0160 Records of Subjects in Health Promotion and Education Studies, HHS/CDC.CHPE	FR Citation: 51 FR 42484

Number of Respondents: 300	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	300	-5,700	6,000
Annual IC Time Burden (Hours)	75	-2,925	3,000
Annual IC Cost Burden (Dollars)	0	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.