Information Collection

Demographic/Clinical Data Collection for Enhanced Surveillance - Molecular

IC 248175 under ICR 202106-0920-007 · OMB 0920-0307.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Demographic/Clinical Data Collection for Enhanced Surveillance - Molecular	Form
Demographic/Clinical Data Elements for Sites Conducting Enhanced Surveillance Demographic/Clinical Data Collection for Enhanced Surveillance - Molecular	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

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

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	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/CDCâ

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 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate
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

table that charts IC Documents
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.