Information Collection Request

Enhanced STD Surveillance Network

ICR 202004-0920-024 · OMB 0920-1072 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 0920-1072 STD Clinic Survey Form and Instruction New Available
Form 0920-1072 Early Syphilis Follow-up (Section 3) Form and Instruction Removed Available
Form 0920-1072 Early Syphilis Cases (Section 2) Form and Instruction Removed Available
Form 0920-1072 Gonorrhea Patient Interview (Section 1) Form and Instruction Modified Available
Att10_table of sensitive questions.docx Supplementary Document Uploaded 2020-04-30 Available
Att9_Det_NonResearch.pdf Supplementary Document Uploaded 2020-04-30 Available
Att7_eSSuNPublications.pdf Supplementary Document Uploaded 2020-04-30 Available
Att6_Collaborators.docx Supplementary Document Uploaded 2020-04-30 Available
Att5_DataElements_DataDisctionary.pdf Supplementary Document Uploaded 2020-04-30 Available
Att4_SSuNProtocol.pdf Supplementary Document Uploaded 2020-04-30 Available
Att3_SummaryofChanges.docx Supplementary Document Uploaded 2020-04-30 Available
Att2_60 Day FRN Published10-25-19.pdf Supplementary Document Uploaded 2020-04-30 Available
Att11_PIA.pdf Supplementary Document Uploaded 2020-04-30 Available
Att1_Auth_Legislation.docx Supplementary Document Uploaded 2020-04-30 Available
Att 11_0920-1072 PIA.pdf Supplementary Document Uploaded 2018-07-27 Available
Att 10_Table of Potentially Sensitive Questions.pdf Supplementary Document Uploaded 2018-07-27 Available
Att 9_CDC Project Determination.pdf Supplementary Document Uploaded 2018-07-27 Available
Att 7_eSSuN_Presentations_Publication_Citations.pdf Supplementary Document Uploaded 2018-07-27 Available
Att 6_Collaborators.pdf Supplementary Document Uploaded 2018-07-27 Available
Att 4_Protocol.pdf Supplementary Document Uploaded 2018-07-27 Available
Att 3_Revisions final.docx Supplementary Document Uploaded 2018-07-27 Available
Att 2b Public comment.docx Supplementary Document Uploaded 2018-07-27 Available
Att 2_60 Day FRN Published.pdf Supplementary Document Uploaded 2018-07-27 Available
Att 1_Auth Legislation.pdf Supplementary Document Uploaded 2018-07-27 Available
Program responses.docx Supplementary Document Uploaded 2015-06-15 Available
SS B.docx Supporting Statement B Uploaded 2020-04-30 Available
SS A.docx Supporting Statement A Uploaded 2020-04-30 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
241635 HIV registry matching Other-HIV Registry New
241634 STD Clinic Survey Form and Instruction New
232379 Data Cleaning/Validation/Reformatting Other-Data Cleaning/Validation Modified
232378 Record Abstraction Other-Data Elements Modified
232377 Early Syphilis Follow-up (Section 3) Form and Instruction Removed
232376 Early Syphilis Cases (Section 2) Form and Instruction Removed
232371 Gonorrhea Patient Interview (Section 1) Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
10/31/2023 36 Months From Approved 09/30/2021
11,263 0 6,281
5,863 0 3,460
0 0 0





table that charts list 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 11,263 6,281 0 5,591 -609 0
Annual Time Burden (Hours) 5,863 3,460 0 2,488 -85 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No