Demographic/Clinical Data Collection for Enhanced Surveillance

Gonococcal Isolate Surveillance Project

Documents and Forms

Document Name Document Type
Demographic/Clinical Data Collection for Enhanced Surveillance Form
Att7 Data Coding Guide.docx Instruction
Att7 Data Coding Guide.docx Instruction
Demographic/Clinical Data Elements for Sites Conducting Att3a2 (Enhanced surveillance clinical &demographic data).csv Form
Demographic/Clinical Data Elements for Sites Conducting Att3a2 (Enhanced surveillance clinical &demographic data).csv Form

Information Collection (IC) Details

IC Title:	Demographic/Clinical Data Collection for Enhanced Surveillance	Agency IC Tracking Number:

Is this a Common Form? No		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	n/a	Demographic/Clinical Data Elements for Sites Conducting Enhanced Surveillance	Att3a2 (Enhanced surveillance clinical &demographic data).csv		Yes	Yes	Fillable Fileable
Instruction			Att7 Data Coding Guide.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0136: Epidemiologic Studies and Surveillance of Disease Problems. HHS/CDC”	FR Citation: 57 FR 62812

Number of Respondents: 10	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	8,400	8,400
Annual IC Time Burden (Hours)	1,680	1,680
Annual IC Cost Burden (Dollars)	32,390	32,390

Documents for IC

Title	Document	Date Uploaded
No associated records found

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