Information Collection Request

SARS-CoV-2 Epidemiologic Data Collections

ICR 202009-0920-012 · OMB 0920-1297 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
General Public - Risk Factor Interview Form and Instruction Unchanged Available
Epidemiologist - Pregnancy Module Form and Instruction Modified Available
Homeless Shelter Staff - Homeless Symptom Follow-Up Form and Instruction Unchanged Available
Homeless Shelter Staff - Homeless Shelter Modified Screener Form and Instruction Unchanged Available
General Public - Household Close-Out Form Form and Instruction Unchanged Available
General Public - Household Animal Queationnaire Form and Instruction Unchanged Available
General Public - Household Member Symptom Diary Form and Instruction Unchanged Available
General Public - Household Questionnaire Form and Instruction Unchanged Available
General Public - Household Contact Questionnaire Instrument Form and Instruction Unchanged Available
General Public - Case Investigation Form Form and Instruction Unchanged Available
Change Request Memo 23SEP2020.docx Justification for No Material/Nonsubstantive Change Uploaded 2020-09-24 Available
22C. NRD_COVID-19 Pregnancy Module.pdf Supplementary Document Uploaded 2020-04-30 Available
22B. NRD_Homeless Shelter Screening.pdf Supplementary Document Uploaded 2020-04-30 Available
22A. Non-research determination.pdf Supplementary Document Uploaded 2020-04-30 Available
23. Homeless project verbal consent.docx Supplementary Document Uploaded 2020-04-30 Available
20.Assent_CHILD_27Apr2020_v1.4_CLEAN.docx Supplementary Document Uploaded 2020-04-30 Available
19. Consent_CASE_27Apr2020_v1.4_CLEAN.docx Supplementary Document Uploaded 2020-04-30 Available
18. Consent_HH MEMBER_27Apr2020_v1.4_CLEAN.docx Supplementary Document Uploaded 2020-04-30 Available
17. Consent_PARENT_27Apr2020_v1.4_CLEAN.docx Supplementary Document Uploaded 2020-04-30 Available
13. Risk Factor_ChartAbstraction0408_Instrument_OMB.docx Supplementary Document Uploaded 2020-04-30 Available
2. 60-day FRN.pdf Supplementary Document Uploaded 2020-04-30 Available
1. Section 301 of the Public Health Service Act (42 USC 241).pdf Supplementary Document Uploaded 2020-04-30 Available
SSB COVID epi forms - NO CF_Clean.docx Supporting Statement B Uploaded 2020-04-29 Available
SSA COVID epi forms - NO CF_Clean.docx Supporting Statement A Uploaded 2020-04-29 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
241646 General Public - Risk Factor Interview Form and Instruction Unchanged
241645 Epidemiologist - Pregnancy Module Form and Instruction Modified
241643 Homeless Shelter Staff - Homeless Symptom Follow-Up Form and Instruction Unchanged
241642 Homeless Shelter Staff - Homeless Shelter Modified Screener Form and Instruction Unchanged
241641 General Public - Household Close-Out Form Form and Instruction Unchanged
241632 General Public - Household Animal Queationnaire Form and Instruction Unchanged
241631 General Public - Household Member Symptom Diary Form and Instruction Unchanged
241630 General Public - Household Questionnaire Form and Instruction Unchanged
241629 General Public - Household Contact Questionnaire Instrument Form and Instruction Unchanged
241628 General Public - Case Investigation Form Form and Instruction Unchanged

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
11/30/2020 11/30/2020 11/30/2020
36,230 0 26,980
16,579 0 16,954
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 36,230 26,980 0 9,250 0 0
Annual Time Burden (Hours) 16,579 16,954 0 -375 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No