Emerging Infections Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-0978 COVID-19 CLOSTRIDIOIDES DIFFICILE INFECTION (CDI) SURVEILLANCE	Form and Instruction	Removed	Available
Form 0920-0978 COVID -19 Invasive Methicillin-Sensitive Staphylococcus aureus Healthcare-Associated Infections Community Interface (HAIC) Case Report – 2020	Form and Instruction	Removed	Available
Form 0920-0978 COVID-19 Invasive Methicillin-Resistant Staphylococcus aureus Healthcare-Associated Infections Community Interface (HAIC) Case Report – 2020	Form and Instruction	Removed	Available
Form 0920-0978 COVID-19 42020 Extended-Spectrum Beta-Lactamase (ESBL)-Producing Enterobacteriaceae MuGSI-HAIC	Form and Instruction	Removed	Available
Form 0920-0978 COVID-19 - Carbapenem Resistant Enterobacteriaceae (CRE)/ Carbapenem Resistant A. baumannii (CRAB) MUGSI-HAIC	Form and Instruction	Removed	Available
Form 0920-0978 2020 Laboratory Testing Practices for Candidemia Questionnaire	Form and Instruction	Unchanged	Available
Form 0920-0978 2019 HAIC Invasive Staphylococcus aureus Supplemental Surveiallance Officer Survey	Form and Instruction	Unchanged	Available
Form 0920-0978 HAIC Staphylococcus aureus Laboratory Survey: Use of Nucleic Acid Amplificaiton Testing (NAAT)	Form and Instruction	Unchanged	Available
Form 0920-0978 Emerging Infections Progrom C. difficile Surveillance Nuring Home Telephone Call Survey	Form and Instruction	Unchanged	Available
Form 0920-0978 Surveillance Officer's Survey	Form and Instruction	Unchanged	Repair queued
Form 0920-0978 Annual Survey of Laboratory Testing Practices for C. difficile Infection	Form and Instruction	Unchanged	Available
Form 0920-0978 FluSurv-NET Laboratory Survey 2019-2020 Season	Form and Instruction	Unchanged	Available
Form 0920-0978 Foodnet Lab Practices Volume	Form and Instruction	Unchanged	Available
Form 0920-0978 Candidemia 2020 Case Report Form	Form and Instruction	Unchanged	Available
Form 0920-0978 Invasive Methicillin-Sensitive Staphylococcus aureau (HAIC) Case Report 2020	Form and Instruction	Modified	Available
Form 0920-0978 2020 Extended-Spectrum Beta-Lactamase (ESBL)- Producting Enterobacteriaceae MuGSI (HAIC)	Form and Instruction	Modified	Available
Form 0920-0978 FluSurv Net Provider Vaccination History Fax Form	Form and Instruction	Unchanged	Available
Form 0920-0978 FluSurv NET Consent Form Spanish	Form and Instruction	Unchanged	Available
Form 0920-0978 FluSurv NET Vaccination Phone Script	Form and Instruction	Unchanged	Repair queued
Form 0920-0978 ABC Severe GAS Infection Supplemental Form	Form and Instruction	Unchanged	Repair queued
Form 0920-0978 ABC H. Influenzae Neonatal Sepsis Expanded Surveillance Form	Form and Instruction	Unchanged	Available
Form 0920-0978 2020 Carbapenem Resistant Enterobacteriaceae (CRE) Carbapenem Resistant A. baumannii (CRAB) Multi-site Gram-Negative Bacilli Case Report Form (MuGSI-CRE/CRAB)	Form and Instruction	Modified	Available
Form 0920-0978 Clostridioides Difficile Infection (CDI Surveillance Emerging Infections Program Case Report	Form and Instruction	Modified	Available
Form 0920-0978 Foodborne and DIarrheal Diseases Message Mapping Guide (FDD MMG - FoodNet only portion)	Form and Instruction	Unchanged	Available
Form 0920-0978 FoodNet Active Surveillance Variable List	Form and Instruction	Unchanged	Available
Form 0920-0978 FoodNet Active Surveillance Variable List	Form and Instruction	Unchanged	Available
Form 0920-0978 FoodNet Active Surveillance Variable List 2019-2020	Form and Instruction	Unchanged	Available
Form 0920-0978 FoodNet Active Surveillance Variable List	Form and Instruction	Unchanged	Available
Form 0920-0978 FoodNet Active Surveillance Variable List	Form and Instruction	Unchanged	Available
Form 0920-0978 FoodNet Active Surveillance Variable List	Form and Instruction	Unchanged	Available
Form 0920-0978 FoodNet Active Surveillance Variable List	Form and Instruction	Unchanged	Available
Form 0920-0978 FluSurv NET Consent From English	Form and Instruction	Unchanged	Available
Form 0920-0978 FluSurv NET Vaccination Phone Script	Form and Instruction	Unchanged	Available
Form 0920-0978 FoodNet HUS CRF	Form and Instruction	Unchanged	Available
Form 0920-0978 2019-2020 FluSurv-NET Influenza Hospitalization Surveillance Project Case Report Form	Form and Instruction	Unchanged	Available
Form 0920-0978 ABC Neonatal Infection Expanded Tracking Form	Form and Instruction	Unchanged	Repair queued
Form 0920-0978 ABC Invasive Pneumococcal Disease in Children (age>2 months to <5 years	Form and Instruction	Unchanged	Available
Form 0920-0978 Invasive Methicillin-Resistant Staphylococcus aureus (MRSA) HAIC Case Report	Form and Instruction	Modified	Available
Form 0920-0978 2020 ABC Surveillance Case Report	Form and Instruction	Unchanged	Available
0920-0978 Change Memo - EIP HAIC COVID-19 CRF additions_updated07242020_CLEAN.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2020-07-29	Available
0920-0978 Change Memo - EIP HAIC COVID-19 CRF additions.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2020-06-24	Available
Att24_Cross walk.pdf	Supplementary Document	Uploaded 2019-12-10	Repair queued
Att23_Description of Changes.pdf	Supplementary Document	Uploaded 2019-12-10	Available
FoodNetSupplemental1_FN Highlights_FDD MMG cross walk_ALL_20190815.xlsx	Supplementary Document	Uploaded 2019-10-25	Available
FoodNetSupplemental2_FoodNet Variable List_mapping to MMG DRAFT.XLSX	Supplementary Document	Uploaded 2019-10-25	Available
Non-Sub ChgReq_0920-0978(121019)_OMBupdates (002).doc	Justification for No Material/Nonsubstantive Change	Uploaded 2019-12-12	Repair queued
Privacy Act Checklist.docx	Supplementary Document	Uploaded 2019-02-22	Available
Attachment 33 - Non-research determination.pdf	Supplementary Document	Uploaded 2019-02-22	Available
Att 32- Flu PIA.pdf	Supplementary Document	Uploaded 2019-02-22	Available
Att 31- ABCs PIA.pdf	Supplementary Document	Uploaded 2019-02-22	Available
Att 30 - FoodNet PIA.pdf	Supplementary Document	Uploaded 2019-02-22	Available
Att 29- HAIC PIA.pdf	Supplementary Document	Uploaded 2019-02-22	Repair queued
60 Day FRN.pdf	Supplementary Document	Uploaded 2019-02-22	Available
Att 1- Authorizing_Regulations_T42_section_241.pdf	Supplementary Document	Uploaded 2019-02-22	Available
Non-sub change request_2018.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2018-09-13	Available
CDI_Non-sub change request_FINAL_20180524.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2018-05-31	Repair queued
Part B_EIP OMB 2018 Revision_20180926.docx	Supporting Statement B	Uploaded 2019-02-22	Available
Part A_EIP OMB 2018 Revision_20180926 ICRO revised.docx	Supporting Statement A	Uploaded 2019-02-22	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
242442	COVID-19 - CDI Case Report and Treatment Form	Form and Instruction	Removed	COVID-19 CLOSTRIDIOIDES DIFFICILE INFECTION (CDI) SURVEILLANCE
242439	COVID-19 - Invasive Methicillin-sensitive Staphylococcus aureus (MSSA) Infection Case Report Form	Form and Instruction	Removed	COVID -19 Invasive Methicillin-Sensitive Staphylococcus aureus Healthcare-Associated Infections Community Interface (HAIC) Case Report – 2020
242425	COVID-19 - Invasive Methicillin-resistant Staphylococcus aureus (MRSA) Infection Case Report Form	Form and Instruction	Removed	COVID-19 Invasive Methicillin-Resistant Staphylococcus aureus Healthcare-Associated Infections Community Interface (HAIC) Case Report – 2020
242423	COVID-19 - MuGSI Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae (ESBL)	Form and Instruction	Removed	COVID-19 42020 Extended-Spectrum Beta-Lactamase (ESBL)-Producing Enterobacteriaceae MuGSI-HAIC
242413	COVID-19 - MuGSI Case Report Form for Carbapenem-resistant Enterobacteriaceae (CRE) and Acinetobacter baumannii (CRAB)	Form and Instruction	Removed	COVID-19 - Carbapenem Resistant Enterobacteriaceae (CRE)/ Carbapenem Resistant A. baumannii (CRAB) MUGSI-HAIC
235058	HAIC Candidemia Periodic Laboratory Survey	Form and Instruction	Unchanged	2020 Laboratory Testing Practices for Candidemia Questionnaire
235057	HAIC Invasive Staphylococcus aureus Annual Surveillance Officers Survey	Form and Instruction	Unchanged	2019 HAIC Invasive Staphylococcus aureus Supplemental Surveiallance Officer Survey
235056	HAIC Invasive Staphylococcus aureus Annual Laboratory Survey	Form and Instruction	Unchanged	HAIC Staphylococcus aureus Laboratory Survey: Use of Nucleic Acid Amplificaiton Testing (NAAT)
235055	HAIC CDI LTCF Survey	Form and Instruction	Unchanged	Emerging Infections Progrom C. difficile Surveillance Nuring Home Telephone Call Survey
235054	HAIC CDI Annual Surveillance Officers Survey	Form and Instruction	Unchanged	Surveillance Officer's Survey
235053	HAIC CDI Annual Laboratory Survey	Form and Instruction	Unchanged	Annual Survey of Laboratory Testing Practices for C. difficile Infection
235052	Flu Surv NET Laboratory Survey	Form and Instruction	Unchanged	FluSurv-NET Laboratory Survey 2019-2020 Season
235051	Foodnet Clinical Laboratory Practices and Testing Volume	Form and Instruction	Unchanged	Foodnet Lab Practices Volume
231114	HAIC Candidemia Case Report Form	Form and Instruction	Unchanged	Candidemia 2020 Case Report Form
231113	HAIC Invasive Methicillin-Sensitive Staphylococcus aureus (MSSA)	Form and Instruction	Modified	Invasive Methicillin-Sensitive Staphylococcus aureau (HAIC) Case Report 2020
231112	HAIC Multi-Site Gram-Negative Surveillance Initiative - Extended Spectrum Beta-Lactamase Producing Enterobacteriaceae (MuGSI-ESBL)	Form and Instruction	Modified	2020 Extended-Spectrum Beta-Lactamase (ESBL)- Producting Enterobacteriaceae MuGSI (HAIC)
231111	Influenza Hospitalization Surveillance Project Provider Vaccination History Fax Form (Children/Adults)	Form and Instruction	Unchanged	FluSurv Net Provider Vaccination History Fax Form
231110	Influenza Hospitalization Surveillance Project Vaccination Telephone Script / Consent Form (Spanish)	Form and Instruction	Unchanged	FluSurv NET Consent Form Spanish
231110	Influenza Hospitalization Surveillance Project Vaccination Telephone Script / Consent Form (Spanish)	Form and Instruction	Unchanged	FluSurv NET Vaccination Phone Script
230869	ABCs Severe GAS Infection Supplemental Form	Form and Instruction	Unchanged	ABC Severe GAS Infection Supplemental Form
220380	ABCs H. Influenzae Neonatal Sepsis Expanded Surveillance Form	Form and Instruction	Unchanged	ABC H. Influenzae Neonatal Sepsis Expanded Surveillance Form
217336	HAIC Multi-Site Gram-Negative Bacilli Case Report Form (MuGSI-CRE/CRAB)	Form and Instruction	Modified	2020 Carbapenem Resistant Enterobacteriaceae (CRE) Carbapenem Resistant A. baumannii (CRAB) Multi-site Gram-Negative Bacilli Case Report Form (MuGSI-CRE/CRAB)
217334	HAIC CDI Case Report Form	Form and Instruction	Modified	Clostridioides Difficile Infection (CDI Surveillance Emerging Infections Program Case Report
207663	FoodNet Yersinia	Form and Instruction	Unchanged	Foodborne and DIarrheal Diseases Message Mapping Guide (FDD MMG - FoodNet only portion)
207662	FoodNet Vibrio	Form and Instruction	Unchanged	FoodNet Active Surveillance Variable List
207661	FoodNet Shigella	Form and Instruction	Unchanged	FoodNet Active Surveillance Variable List
207660	FoodNet Shiga toxin producing E. coli	Form and Instruction	Unchanged	FoodNet Active Surveillance Variable List 2019-2020
207659	FoodNet Salmonella	Form and Instruction	Unchanged	FoodNet Active Surveillance Variable List
207658	FoodNet Listeria monocytogenes	Form and Instruction	Unchanged	FoodNet Active Surveillance Variable List
207657	FoodNet Cyclospora	Form and Instruction	Unchanged	FoodNet Active Surveillance Variable List
207655	FoodNet Campylobacter	Form and Instruction	Unchanged	FoodNet Active Surveillance Variable List
207653	Influenza Hospitalization Surveillance Project Vaccination Telephone Script / Consent Form (English)	Form and Instruction	Unchanged	FluSurv NET Consent From English
207653	Influenza Hospitalization Surveillance Project Vaccination Telephone Script / Consent Form (English)	Form and Instruction	Unchanged	FluSurv NET Vaccination Phone Script
207652	FoodNet Hemolytic Uremic Syndrome (HUS)	Form and Instruction	Unchanged	FoodNet HUS CRF
207651	Influenza Hospitalization Surveilance Network Case Report Form	Form and Instruction	Unchanged	2019-2020 FluSurv-NET Influenza Hospitalization Surveillance Project Case Report Form
207649	ABCs Neonatal Infection Expanded Tracking Form	Form and Instruction	Unchanged	ABC Neonatal Infection Expanded Tracking Form
207648	ABCs Invasive Pneumococcal Disease in Children	Form and Instruction	Unchanged	ABC Invasive Pneumococcal Disease in Children (age>2 months to <5 years
207647	HAIC Invasive Methicillin-resistant Staphylococcus aureus (MRSA)	Form and Instruction	Modified	Invasive Methicillin-Resistant Staphylococcus aureus (MRSA) HAIC Case Report
207646	ABCs Case Report Form	Form and Instruction	Unchanged	2020 ABC Surveillance Case Report

ICR Details

OMB Control No: 0920-0978	ICR Reference No: 202007-0920-014
Status: Historical Active	Previous ICR Reference No: 202006-0920-015
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-0978-20QT
Title: Emerging Infections Program
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 07/31/2020
Retrieve Notice of Action (NOA)	Date Received in OIRA: 07/29/2020
Terms of Clearance: Previous terms continue: OMB is approving this information collection request for a period of three years during which time CDC will request approval to extend or revise the collection if the agency seeks to continue the information collection activity beyond the period approved under this action. Similarly, any changes to EIP as a result of ETEC pilot will be submitted for review and approval prior to fielding the data collection. Finally, approval is consistent with the understanding that CDC will continue to add language to its website and reports that clearly caveats the interpretation of longitudinal trends due to changes in the number and characteristics of participating hospitals

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2022	04/30/2022	04/30/2022
Responses	99,955	0	138,735
Time Burden (Hours)	39,673	0	40,816
Cost Burden (Dollars)	0	0	0

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Abstract: The Emerging Infections Programs (EIP) is to 1) detect and monitor emerging pathogens, the diseases they cause, and the factors influencing their emergence, and respond to problems as they are identified, 2) integrate laboratory science and epidemiology to optimize public health practice, 3) strengthen infrastructure to support surveillance and research and to implement prevention and control programs, and to 4) ensure implementation of prevention strategies and communication of public health information about emerging diseases. Surveillance efforts of the core EIP activities generate reliable estimates of the incidence of certain infections and provide the foundation for a variety of epidemiologic studies. This is a request for a non-substantive change. Requested changes represent minor modifications to already-approved instruments to include a limited number of data elements pertaining to COVID-19.

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Authorizing Statute(s): US Code: 42 USC 301 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 57488	11/15/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 5685	02/22/2019
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 32

table that charts list of burden

IC Title	Form No.	Form Name
ABCs Case Report Form	0920-0978	2020 ABC Surveillance Case Report
ABCs H. Influenzae Neonatal Sepsis Expanded Surveillance Form	0920-0978	ABC H. Influenzae Neonatal Sepsis Expanded Surveillance Form
ABCs Invasive Pneumococcal Disease in Children	0920-0978	ABC Invasive Pneumococcal Disease in Children (age>2 months to <5 years
ABCs Neonatal Infection Expanded Tracking Form	0920-0978	ABC Neonatal Infection Expanded Tracking Form
ABCs Severe GAS Infection Supplemental Form	0920-0978	ABC Severe GAS Infection Supplemental Form
COVID-19 - CDI Case Report and Treatment Form	0920-0978	COVID-19 CLOSTRIDIOIDES DIFFICILE INFECTION (CDI) SURVEILLANCE
COVID-19 - Invasive Methicillin-resistant Staphylococcus aureus (MRSA) Infection Case Report Form	0920-0978	COVID-19 Invasive Methicillin-Resistant Staphylococcus aureus Healthcare-Associated Infections Community Interface (HAIC) Case Report – 2020
COVID-19 - Invasive Methicillin-sensitive Staphylococcus aureus (MSSA) Infection Case Report Form	0920-0978	COVID -19 Invasive Methicillin-Sensitive Staphylococcus aureus Healthcare-Associated Infections Community Interface (HAIC) Case Report – 2020
COVID-19 - MuGSI Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae (ESBL)	0920-0978	COVID-19 42020 Extended-Spectrum Beta-Lactamase (ESBL)-Producing Enterobacteriaceae MuGSI-HAIC
COVID-19 - MuGSI Case Report Form for Carbapenem-resistant Enterobacteriaceae (CRE) and Acinetobacter baumannii (CRAB)	0920-0978	COVID-19 - Carbapenem Resistant Enterobacteriaceae (CRE)/ Carbapenem Resistant A. baumannii (CRAB) MUGSI-HAIC
Flu Surv NET Laboratory Survey	0920-0978	FluSurv-NET Laboratory Survey 2019-2020 Season
FoodNet Campylobacter	0920-0978	FoodNet Active Surveillance Variable List
FoodNet Cyclospora	0920-0978	FoodNet Active Surveillance Variable List
FoodNet Hemolytic Uremic Syndrome (HUS)	0920-0978	FoodNet HUS CRF
FoodNet Listeria monocytogenes	0920-0978	FoodNet Active Surveillance Variable List
FoodNet Salmonella	0920-0978	FoodNet Active Surveillance Variable List
FoodNet Shiga toxin producing E. coli	0920-0978	FoodNet Active Surveillance Variable List 2019-2020
FoodNet Shigella	0920-0978	FoodNet Active Surveillance Variable List
FoodNet Vibrio	0920-0978	FoodNet Active Surveillance Variable List
FoodNet Yersinia	0920-0978	Foodborne and DIarrheal Diseases Message Mapping Guide (FDD MMG - FoodNet only portion)
Foodnet Clinical Laboratory Practices and Testing Volume	0920-0978	Foodnet Lab Practices Volume
HAIC CDI Annual Laboratory Survey	0920-0978	Annual Survey of Laboratory Testing Practices for C. difficile Infection
HAIC CDI Annual Surveillance Officers Survey	0920-0978	Surveillance Officer's Survey
HAIC CDI Case Report Form	0920-0978	Clostridioides Difficile Infection (CDI Surveillance Emerging Infections Program Case Report
HAIC CDI LTCF Survey	0920-0978	Emerging Infections Progrom C. difficile Surveillance Nuring Home Telephone Call Survey
HAIC Candidemia Case Report Form	0920-0978	Candidemia 2020 Case Report Form
HAIC Candidemia Periodic Laboratory Survey	0920-0978	2020 Laboratory Testing Practices for Candidemia Questionnaire
HAIC Invasive Methicillin-Sensitive Staphylococcus aureus (MSSA)	0920-0978	Invasive Methicillin-Sensitive Staphylococcus aureau (HAIC) Case Report 2020
HAIC Invasive Methicillin-resistant Staphylococcus aureus (MRSA)	0920-0978	Invasive Methicillin-Resistant Staphylococcus aureus (MRSA) HAIC Case Report
HAIC Invasive Staphylococcus aureus Annual Laboratory Survey	0920-0978	HAIC Staphylococcus aureus Laboratory Survey: Use of Nucleic Acid Amplificaiton Testing (NAAT)
HAIC Invasive Staphylococcus aureus Annual Surveillance Officers Survey	0920-0978	2019 HAIC Invasive Staphylococcus aureus Supplemental Surveiallance Officer Survey
HAIC Multi-Site Gram-Negative Bacilli Case Report Form (MuGSI-CRE/CRAB)	0920-0978	2020 Carbapenem Resistant Enterobacteriaceae (CRE) Carbapenem Resistant A. baumannii (CRAB) Multi-site Gram-Negative Bacilli Case Report Form (MuGSI-CRE/CRAB)
HAIC Multi-Site Gram-Negative Surveillance Initiative - Extended Spectrum Beta-Lactamase Producing Enterobacteriaceae (MuGSI-ESBL)	0920-0978	2020 Extended-Spectrum Beta-Lactamase (ESBL)- Producting Enterobacteriaceae MuGSI (HAIC)
Influenza Hospitalization Surveilance Network Case Report Form	0920-0978	2019-2020 FluSurv-NET Influenza Hospitalization Surveillance Project Case Report Form
Influenza Hospitalization Surveillance Project Provider Vaccination History Fax Form (Children/Adults)	0920-0978	FluSurv Net Provider Vaccination History Fax Form
Influenza Hospitalization Surveillance Project Vaccination Telephone Script / Consent Form (English)	0920-0978, 0920-0978	FluSurv NET Vaccination Phone Script ,   FluSurv NET Consent From English
Influenza Hospitalization Surveillance Project Vaccination Telephone Script / Consent Form (Spanish)	0920-0978, 0920-0978	FluSurv NET Vaccination Phone Script ,   FluSurv NET Consent Form Spanish

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ICR Summary of Burden

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	99,955	138,735	0	0	-38,780	0
Annual Time Burden (Hours)	39,673	40,816	0	2,089	-3,232	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: Addition of COVID-19 related questions to 0920-0978 EIP Forms results in increased burden hours for some instruments but an overall decrease due to entry error on last submission.

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Annual Cost to Federal Government: $31,091,990

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? Yes

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Common Form ICR:  No

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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: 07/29/2020

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