Information Collection

Territories - Weekly, quarterly - non-automated

IC 228442 under ICR 201810-0920-008 · 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⚠️ Notice: This information collection may be referencing outdated material.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 8 - Core Data.xlsx	Other-Data elements
Att 9- Laboratory Data.xlsx	Other-Data elements
Att 10 - Vaccine Data.xlsx	Other-Data elements
Att 11 - VPD Data.xlsx	Other-Data elements
Att 13 - 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

IC Title:

Territories - Weekly, quarterly - non-automated

Agency IC Tracking Number:

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Data elements	Att 10 - Vaccine Data.xlsx	Yes	Yes	Fillable Fileable
Other-Data elements	Att 9- Laboratory Data.xlsx	Yes	Yes	Fillable Fileable
Other-Data elements	Att 11 - VPD Data.xlsx	Yes	Yes	Fillable Fileable
Other-Data elements	Att 13 - Disease-Specific Data.xlsx	Yes	Yes	Fillable Fileable
Other-Data elements	Att 8 - Core 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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	280	0	280
Annual IC Time Burden (Hours)	93	0	93
Annual IC Cost Burden (Dollars)	3,422	-67	3,489

Documents for IC

table that charts IC Documents
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.