Information Collection

Territories - Weekly, quarterly - non-automated

IC 228442 under ICR 202110-0920-014 · OMB 0920-0728.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0728 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att 5 - Core Data_CR_06072021.xlsx	Other-Data elements
Att 5 - Core Data_CR_06072021.xlsx	Other-Data elements
Att 6 - Laboratory Data_CR_06072021.xlsx	Other-Data elements
Att 6 - Laboratory Data_CR_06072021.xlsx	Other-Data elements
Att 8 - Vaccine Data.xlsx	Other-Data elements
Att 8 - Vaccine Data.xlsx	Other-Data elements
Att 9 - VPD Data.xlsx	Other-Data elements
Att 9 - VPD Data.xlsx	Other-Data elements
Att 11 - Disease-Specific Data_CR_07022021.xlsx	Other-Data elements
Att 11 - Disease-Specific Data_CR_07022021.xlsx	Other-Data elements
Att 5 - Core Data_CR_10272021.xlsx	Other-Updated Data elements
Att 11 - Disease-Specific Data_CR_10272021.xlsx	Other-Updated Data elements
Att 11 - Disease-Specific Data_CR_11022021.xlsx	Other-Updated Data elements
Attachment 4 Core Data.xlsx Attachment 4 Core Data	IC Document
Attachment 4 Core Data.xlsx Attachment 4 Core Data	IC Document
Attachment 5 Disease-Specific Data.xlsx Attachment 5 Disease-Specific Data	IC Document
Attachment 5 Disease-Specific Data.xlsx Attachment 5 Disease-Specific Data	IC Document
Att 4 - Core Data.xlsx	IC Document
Att 4 - Core Data.xlsx	IC Document

IC Title:

Territories - Weekly, quarterly - non-automated

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Data elements	Att 5 - Core Data_CR_06072021.xlsx	Yes	Yes	Fillable Fileable
Other-Data elements	Att 6 - Laboratory Data_CR_06072021.xlsx	Yes	Yes	Fillable Fileable
Other-Data elements	Att 8 - Vaccine Data.xlsx	Yes	Yes	Fillable Fileable
Other-Data elements	Att 9 - VPD Data.xlsx	Yes	Yes	Fillable Fileable
Other-Data elements	Att 11 - Disease-Specific Data_CR_07022021.xlsx	Yes	Yes	Fillable Fileable
Other-Updated Data elements	Att 11 - Disease-Specific Data_CR_11022021.xlsx	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

FR Citation: 76 FR 4458

Number of Respondents: 5

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	280	280
Annual IC Time Burden (Hours)	93	93
Annual IC Cost Burden (Dollars)	3,514	3,514

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 4 Core Data	Attachment 4 Core Data.xlsx	11/13/2013
Attachment 5 Disease-Specific Data	Attachment 5 Disease-Specific Data.xlsx	11/13/2013
	Att 4 - Core Data.xlsx	09/21/2015

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