Enhanced STD Surveillance Network

Forms and Documents

Document Name	Status
Form 0920-1072 Early Syphilis Follow-up (Section 3) Form and Instruction	New
Form 0920-1072 Early Syphilis Cases (Section 2) Form and Instruction	New
Form 0920-1072 Gonorrhea Patient Interview (Section 1) Form and Instruction	New
Gonnorhea Case Surveillance Form and Instruction	Removed
Gonorrhea Patient Interview Form and Instruction	Removed
STD Clinic-based Surveillance Form and Instruction	Removed
Att 11_0920-1072 PIA.pdf Supplementary Document	2018-07-27
Att 10_Table of Potentially Sensitive Questions.pdf Supplementary Document	2018-07-27
Att 9_CDC Project Determination.pdf Supplementary Document	2018-07-27
Att 7_eSSuN_Presentations_Publication_Citations.pdf Supplementary Document	2018-07-27
Att 6_Collaborators.pdf Supplementary Document	2018-07-27
Att 4_Protocol.pdf Supplementary Document	2018-07-27
Att 3_Revisions final.docx Supplementary Document	2018-07-27
Att 2b Public comment.docx Supplementary Document	2018-07-27
Att 2_60 Day FRN Published.pdf Supplementary Document	2018-07-27
Att 1_Auth Legislation.pdf Supplementary Document	2018-07-27
Program responses.docx Supplementary Document	2015-06-15
SSB_LL07102018.docx Supporting Statement B	2018-07-25
SSA final.docx Supporting Statement A	2018-07-27

IC Document Collections

IC ID	Document Title	Status
232379	Data Cleaning/Validation/Reformatting Other-Data cleaning	New
232378	Record Abstraction Other-Data elements	New
232377	Early Syphilis Follow-up (Section 3) Form and Instruction	New
232376	Early Syphilis Cases (Section 2) Form and Instruction	New
232371	Gonorrhea Patient Interview (Section 1) Form and Instruction	New
214282	Gonnorhea Case Surveillance Form and Instruction	Removed
214281	Gonorrhea Patient Interview Form and Instruction	Removed
214279	STD Clinic-based Surveillance Form and Instruction	Removed

ICR Details

OMB Control No: 0920-1072	ICR Reference No: 201807-0920-010
Status: Historical Active	Previous ICR Reference No: 201412-0920-010
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-1072
Title: Enhanced STD Surveillance Network
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/12/2018
	Date Received in OIRA: 08/08/2018
Terms of Clearance: Approved consistent with the understanding that CDC will continue to discribe (in the supporting statement) efforts taken to increase internal coordination of CDC activities to reduce burden on the states from multiple STD reporting systems.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2021	36 Months From Approved	06/30/2018
Responses	6,281	0	3,477
Time Burden (Hours)	3,460	0	2,854
Cost Burden (Dollars)	0	0	0

---

Abstract: The Enhanced STD Surveillance Network (eSSuN) is a network of local and state health departments (10) who perform active surveillance and provide detailed information on demographic characteristics, behavioral risk factors, and clinical history 1) on persons who attend participating STD clinics and Family planning/ Reproductive health clinics in one of the 10 cities around the US and 2) on a random sample of persons diagnosed with gonorrhea within the participating SSuN jurisdictions. This information will enable public health officials to understand important characteristics of persons tested, diagnosed, and treated for STDs, inform and guide state/local and national programs and policies for STD control, and identify and evaluate the effectiveness of public health interventions to reduce STD morbidity.

---

Authorizing Statute(s): US Code: 42 USC 41 Name of Law: PHSA
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 11532	03/15/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 39100	08/08/2018
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 5

IC Title	Form No.	Form Name
Gonorrhea Patient Interview (Section 1)	0920-1072	Gonorrhea Patient Interview section 1
STD Clinic-based Surveillance	none	Facility Surveillance Data Elements
Early Syphilis Cases (Section 2)	0920-1072	Early Syphilis Cases (Section 2)
Gonorrhea Patient Interview	none	Patient Interview Script
Gonnorhea Case Surveillance	none	Case Surveillance by Health Department Manager
Early Syphilis Follow-up (Section 3)	0920-1072	Early Syphilis Follow-up (Section 3)
Record Abstraction
Data Cleaning/Validation/Reformatting

---

ICR Summary 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	6,281	3,477	0	6,281	-3,477	0
Annual Time Burden (Hours)	3,460	2,854	0	3,460	-2,854	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: No

Burden Reduction Due to:

Short Statement: Burden differences due to modifications in the number of respondents and collection instruments.

---

Annual Cost to Federal Government: $3,054,367

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.     Yes

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

---

Common Form ICR:  No

---

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: 08/08/2018

---