2019-nCoV Investigation, United States, 2020

Emergency Epidemic Investigation Data Collections - Expedited Reviews (Y3Q4)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1011 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-1011 2019-nCoV Investigation, United States, 2020 Form and Instruction
0920-1011 2019 nCoV Case Report Form Appendix 1 2019-nCoV Case Report Form (revised) (002).docx Form and Instruction
0920-1011 2019 nCoV PUI Form Appendix 2 2019-nCoV PUI Form (revised).docx Form and Instruction
0920-1011 2019 nCoV Household Close Contact Investigation Appendix 3 2019-nCoV nCoV Household-Close Contact Investigation Form (revised).docx Form and Instruction
0920-1011 Severe Pulmonary Disease Associatd with E-Cigarette Use Appendix 2. Data Collection Forms.pdf Form and Instruction
EpiAid_LetterOfSupport_NoCoVResponseOMBInitial_01222020.pdf EpiAid Letter of Support 2019 nCoV IC Document
2020002-XXX nCoV_multi.docx GenIC Request EEI IC Document
Burden Memo Email 2019 nCoV.msg Burden Memo Email IC Document

Information Collection (IC) Details

IC Title:	2019-nCoV Investigation, United States, 2020	Agency IC Tracking Number:	0920-1011

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 and Instruction	0920-1011	2019 nCoV Case Report Form	Appendix 1 2019-nCoV Case Report Form (revised) (002).docx	NA	No		Paper Only
Form and Instruction	0920-1011	2019 nCoV PUI Form	Appendix 2 2019-nCoV PUI Form (revised).docx	NA	No		Paper Only
Form and Instruction	0920-1011	2019 nCoV Household Close Contact Investigation	Appendix 3 2019-nCoV nCoV Household-Close Contact Investigation Form (revised).docx	NA	No		Paper Only
Form and Instruction	0920-1011	Severe Pulmonary Disease Associatd with E-Cigarette Use Outbreak (Case Interview Short Form (CDC))	Appendix 2. Data Collection Forms.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: Epidemic Investigation Case Records - SORN number 09-20-0113	FR Citation: 51 FR 42466

Number of Respondents: 3,966	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	3,966	766	3,200
Annual IC Time Burden (Hours)	3,926	2,326	1,600
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
EpiAid Letter of Support 2019 nCoV	EpiAid_LetterOfSupport_NoCoVResponseOMBInitial_01222020.pdf	01/24/2020
GenIC Request EEI	2020002-XXX nCoV_multi.docx	01/24/2020
Burden Memo Email	Burden Memo Email 2019 nCoV.msg	01/24/2020

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