Information Collection

Territories - One time addition of diseases and data elements

IC 228445 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⚠️ Notice: This information collection may be referencing outdated material.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 11 - Disease-Specific Data_CR_08042021.xlsx	Other-Data Elements
Att 11 - Disease-Specific Data_CR_08042021.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 - One time addition of diseases and data elements

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Data elements		Yes	Yes	Fillable Fileable
Other-Data elements		Yes	Yes	Fillable Fileable
Other-Data elements		Yes	Yes	Fillable Fileable
Other-Data elements		Yes	Yes	Fillable Fileable
Other-Data elements		Yes	Yes	Fillable Fileable
Other-Data Elements	NA	Yes	Yes	Fillable Fileable
Other-Updated Data elements		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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	5	0	5
Annual IC Time Burden (Hours)	80	3	77
Annual IC Cost Burden (Dollars)	3,467	0	3,467

Documents for IC

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

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

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