Integrated Viral Hepatitis Surveillance and Prevention Funding for Health Departments

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-21EE Att 3f_Acute Viral Hepatitis Case Reporting	Form	New	Available
Form 0920-21EE Acute Viral Hepatitis Case Reporting	Form	New	Repair queued
Form 0920-21EE Att 3e_Outbreak Summary Report	Form and Instruction	New	Repair queued
Form 0920-21EE Outbreak Summary Report Form	Form	New	Repair queued
Form 0920-21EE Att 3d_Initial Outbreak Report	Form and Instruction	New	Available
Form 0920-21EE Initial Outbreak Report Form	Form	New	Repair queued
Form 0920-21EE 3c_Component 3	Form	New	Available
Form 0920-21EE Component 3: Special Projects	Form	New	Repair queued
Form 0920-21EE Att 3b_Component 2	Form	New	Available
Form 0920-21EE Core Viral Hepatitis Outbreak Prevention Activities	Form	New	Repair queued
Form 0920-21EE 3a_Component 1	Form	New	Available
Form 0920-21EE Core Viral Hepatitis Outbreak Response and Surveillance Activities	Form	New	Repair queued
Att 1_ Authorizing Legislation.pdf	Supplementary Document	Uploaded 2021-08-02	Repair queued
SSA_7-12-2021.docx	Supporting Statement A	Uploaded 2021-08-02	Available
Att 10_PCSIDataSecurityGuidelines.pdf	Supplementary Document	Uploaded 2021-08-02	Repair queued
Att 9_2019HepSurveillanceRpt.pdf	Supplementary Document	Uploaded 2021-08-02	Repair queued
Att 8_IRB Project Determination.pdf	Supplementary Document	Uploaded 2021-08-02	Repair queued
Att 6_GuidelinesVHSurveillance.pdf	Supplementary Document	Uploaded 2021-08-02	Repair queued
Att 4c_Comp 3 instructions_5-18-2021.docx	Supplementary Document	Uploaded 2021-08-02	Repair queued
Att 5_HepatitisCaseRprtForm.pdf	Supplementary Document	Uploaded 2021-08-02	Repair queued
Att 4b_Comp 2 instructions_5-28-2021.docx	Supplementary Document	Uploaded 2021-08-02	Repair queued
Att 4a_Comp 1 instructions_5-18-2021.docx	Supplementary Document	Uploaded 2021-08-02	Repair queued
SSB_6-9-2021.docx	Supporting Statement B	Uploaded 2021-08-02	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
248662	Acute Viral Hepatitis Case Reporting	Form	New	Att 3f_Acute Viral Hepatitis Case Reporting
248662	Acute Viral Hepatitis Case Reporting	Form	New
248661	Outbreak Summary Report Form	Form and Instruction	New	Att 3e_Outbreak Summary Report
248661	Outbreak Summary Report Form	Form	New
248660	Initial Outbreak Report Form	Form and Instruction	New	Att 3d_Initial Outbreak Report
248660	Initial Outbreak Report Form	Form	New
248659	Component 3: Special Projects	Form	New	3c_Component 3
248659	Component 3: Special Projects	Form	New
248657	Core Viral Hepatitis Outbreak Prevention Activities	Form	New	Att 3b_Component 2
248657	Core Viral Hepatitis Outbreak Prevention Activities	Form	New
248655	Core Viral Hepatitis Outbreak Response and Surveillance Activities	Form	New	3a_Component 1
248655	Core Viral Hepatitis Outbreak Response and Surveillance Activities	Form	New

ICR Details

OMB Control No: 0920-1353	ICR Reference No: 202108-0920-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-21EE
Title: Integrated Viral Hepatitis Surveillance and Prevention Funding for Health Departments
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  Yes
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 11/05/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/03/2021
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2024	36 Months From Approved
Responses	427	0	0
Time Burden (Hours)	239	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Tools exist to prevent new cases of hepatitis A, B, and C, to treat people living with hepatitis B, and to cure people living with hepatitis C. Yet new cases of viral hepatitis (VH) continue to rise, many people infected with VH remain undiagnosed, and far too many VH-related deaths occur in the US each year. This project will enable states to collect data to evaluate disease burden and trends and to analyze and disseminate that data to develop or refine recommendations, policies, and practices that will ultimately reduce the burden of VH in their jurisdictions.

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Authorizing Statute(s): None

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:
	86 FR 20161	04/16/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 41472	08/02/2021
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 6

table that charts list of burden

IC Title	Form No.	Form Name
Acute Viral Hepatitis Case Reporting	0920-21EE	Att 3f_Acute Viral Hepatitis Case Reporting
Component 3: Special Projects	0920-21EE	3c_Component 3
Core Viral Hepatitis Outbreak Prevention Activities	0920-21EE	Att 3b_Component 2
Core Viral Hepatitis Outbreak Response and Surveillance Activities	0920-21EE	3a_Component 1
Initial Outbreak Report Form	0920-21EE	Att 3d_Initial Outbreak Report
Outbreak Summary Report Form	0920-21EE	Att 3e_Outbreak Summary Report

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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	427	0	0	427	0	0
Annual Time Burden (Hours)	239	0	0	239	0	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: This is a new collection. The total estimated burden in hours for this ICR is 239 annual burden hours for three years of approval.

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Annual Cost to Federal Government: $22,445,790

Does this IC contain surveys, censuses, or employ statistical methods? No

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.     No

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? No

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Common Form ICR:  Yes

Description/Changes for Common Form Usage: 

Approved RCFs using this ICR

table that charts list of RCF

Agency/Sub Agency	RCF ID	RCF Title	RCF Status	IC Title

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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: 08/03/2021

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