Information Collection

Territories - One time addition of diseases and data elements

IC 228445 under ICR 202002-0920-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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 10 - Disease-Specific Data.xlsx Other-Data elements
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 - VPD 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 - One time addition of diseases and data elements	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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 10 - Disease-Specific Data.xlsx	Yes	Yes	Fillable Fileable
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 - VPD 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	Previously Approved
Annual Number of Responses for this IC	5	0	5
Annual IC Time Burden (Hours)	15	-50	65
Annual IC Cost Burden (Dollars)	693	-2,205	2,898

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.