Information Collection

Cluster Follow-up Report

IC 236511 under ICR 202012-0920-004 · OMB 0920-0573.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0573 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Cluster Follow-up Report	Form and Instruction
Cluster Follow-up Form Att 3g_ Cluster Follow Up Form_rev18Jun19pdf.pdf	Form and Instruction
Att 4f_Cluster Investigation Report Form Instructions 9.10.1.pdf Instructions: Cluster Investigation Reporting	IC Document

IC Title:

Cluster Follow-up Report

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	n/a	Cluster Follow-up Form	Att 3g_ Cluster Follow Up Form_rev18Jun19pdf.pdf		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 HHS/CDC

FR Citation: 57 FR 62812

Number of Respondents: 59

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	295	295
Annual IC Time Burden (Hours)	148	148
Annual IC Cost Burden (Dollars)	3,983	3,983

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Instructions: Cluster Investigation Reporting	Att 4f_Cluster Investigation Report Form Instructions 9.10.1.pdf	06/26/2019

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