Information Collection for Tuberculosis Data from Referring Entities to CureTB

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
CureTB Partner Feedback	Form and Instruction	New	Repair queued
CureTB Partner Feedback (at completion of referred patient's treatment)	Form and Instruction	New	Repair queued
CureTB Partner Feedback	Form and Instruction	New	Available
CureTB Partner Feedback (at time of patient referral)	Form and Instruction	New	Repair queued
CureTB Transnational Notificaiton	Form and Instruction	Unchanged	Available
Individual Followup with Tuberculosis (TB) Patients Referred by ICE	Form and Instruction	Unchanged	Repair queued
Telephone Script for Clinician/Foreign Health Authority Referral Follow-up	Form and Instruction	Unchanged	Available
Coordination with TB Treating Physician/Foreign Health Authority in New Country	Form and Instruction	Unchanged	Repair queued
CureTB Contact/Source Investigation (CI/SI) Notification	Form and Instruction	Unchanged	Available
Cure TB Contact Source Investigation (CI/SI) Notification - LHD	Form and Instruction	Unchanged	Repair queued
CureTB Transnational Notification	Form and Instruction	Unchanged	Available
Individual Followup with Tuberculosis (TB) Patients Referred by LHD	Form and Instruction	Unchanged	Repair queued
CureTB Transnational Notification	Form and Instruction	Unchanged	Available
Cure TB Transnational Notification - Referral from Local Health Departments	Form and Instruction	Unchanged	Repair queued
Nonsub Change Request_CureTB Assessment.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2022-03-17	Repair queued
Att. G 20200520 CureTB PIA Signed.pdf	Supplementary Document	Uploaded 2020-06-15	Available
SSA-CureTB06.15.2020-Final.docx	Supporting Statement A	Uploaded 2020-06-15	Repair queued
Att. F - IRB Determination.pdf	Supplementary Document	Uploaded 2020-06-08	Repair queued
Att. B - Published 60-day FRN-12.23.2019.pdf	Supplementary Document	Uploaded 2020-06-08	Repair queued
Att. A5 - Section 311.pdf	Supplementary Document	Uploaded 2020-06-08	Repair queued
Att. A4 - Section 301.pdf	Supplementary Document	Uploaded 2020-06-08	Repair queued
Att. A3 - 42 CFR Part 71.pdf	Supplementary Document	Uploaded 2020-06-08	Repair queued
Att. A2 - 42 CFR Part 70.pdf	Supplementary Document	Uploaded 2020-06-08	Repair queued
Att. A1 - Section 361 of the Public Health Service Act (42 USC 264).pdf	Supplementary Document	Uploaded 2020-06-08	Available
SSB-CureTB5.29.2020-Final.docx	Supporting Statement B	Uploaded 2020-06-08	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
252225	CureTB Partner Feedback (at completion of referred patient's treatment)	Form and Instruction	New	CureTB Partner Feedback
252225	CureTB Partner Feedback (at completion of referred patient's treatment)	Form and Instruction	New
252225	CureTB Partner Feedback (at completion of referred patient's treatment)	Other-Questionnaire annotated with skip logic	New
252223	CureTB Partner Feedback (at time of patient referral)	Form and Instruction	New	CureTB Partner Feedback
252223	CureTB Partner Feedback (at time of patient referral)	Form and Instruction	New
252223	CureTB Partner Feedback (at time of patient referral)	Other-Questionnaire annotated with skip logic	New
242057	Individual Followup with Tuberculosis (TB) Patients Referred by ICE	Form and Instruction	Unchanged	CureTB Transnational Notificaiton
242057	Individual Followup with Tuberculosis (TB) Patients Referred by ICE	Form and Instruction	Unchanged
226739	Coordination with TB Treating Physician/Foreign Health Authority in New Country	Form and Instruction	Unchanged	Telephone Script for Clinician/Foreign Health Authority Referral Follow-up
226739	Coordination with TB Treating Physician/Foreign Health Authority in New Country	Form and Instruction	Unchanged
226738	Cure TB Contact Source Investigation (CI/SI) Notification - LHD	Form and Instruction	Unchanged	CureTB Contact/Source Investigation (CI/SI) Notification
226738	Cure TB Contact Source Investigation (CI/SI) Notification - LHD	Form and Instruction	Unchanged
226737	Individual Followup with Tuberculosis (TB) Patients Referred by LHD	Form and Instruction	Unchanged	CureTB Transnational Notification
226737	Individual Followup with Tuberculosis (TB) Patients Referred by LHD	Form and Instruction	Unchanged
226736	Cure TB Transnational Notification - Referral from Local Health Departments	Form and Instruction	Unchanged	CureTB Transnational Notification
226736	Cure TB Transnational Notification - Referral from Local Health Departments	Form and Instruction	Unchanged

ICR Details

OMB Control No: 0920-1186	ICR Reference No: 202203-0920-003
Status: Historical Active	Previous ICR Reference No: 202004-0920-019
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-22DH
Title: Information Collection for Tuberculosis Data from Referring Entities to CureTB
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/04/2022
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/17/2022
Terms of Clearance: In CDC's next revision, extension, or reinstatement request, CDC shall ensure that this collection complies with 5 CFR 1320.8(b)(3) and a submit a copy of all then-effective public guidance issued by CDC on completing this collection (if any) with the package. CDC is also encouraged to consider and report in this next revision, extension, or reinstatement request whether there is a material amount of non-response due to respondent concern about HIPAA or 42 CFR Part 2, and whether steps could be taken to mitigate that non-response.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/29/2024	02/29/2024	02/29/2024
Responses	3,914	0	3,764
Time Burden (Hours)	1,103	0	1,081
Cost Burden (Dollars)	31,105	0	30,139

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Abstract: The objective of this information collection is to facilitate CDC coordinating of the continuity of care for individuals affected by TB who enter US jurisdictions from foreign nations who or who leave US jurisdictions bound for foreign nations.

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Authorizing Statute(s): US Code: 42 USC Code of Federal Regulations Name of Law: Public Health Service Act
   US Code: 42 USC Code of Federal Regulations Name of Law: Part 70 Interstate Quarantine
   US Code: 42 USC Code of Federal Regulations Name of Law: Part 71 Foreign Quarantine
  

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:
	84 FR 70555	12/23/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 36211	06/15/2020
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 7

table that charts list of burden

IC Title	Form No.	Form Name
Coordination with TB Treating Physician/Foreign Health Authority in New Country	n/a	Telephone Script for Clinician/Foreign Health Authority Referral Follow-up
Cure TB Contact Source Investigation (CI/SI) Notification - LHD	n/a	CureTB Contact/Source Investigation (CI/SI) Notification
Cure TB Transnational Notification - Referral from Local Health Departments	n/a	CureTB Transnational Notification
CureTB Partner Feedback (at completion of referred patient's treatment)	n/a	CureTB Partner Feedback
CureTB Partner Feedback (at time of patient referral)	n/a	CureTB Partner Feedback
Individual Followup with Tuberculosis (TB) Patients Referred by ICE	n/a	CureTB Transnational Notificaiton
Individual Followup with Tuberculosis (TB) Patients Referred by LHD	n/a	CureTB Transnational Notification

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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	3,914	3,764	0	150	0	0
Annual Time Burden (Hours)	1,103	1,081	0	22	0	0
Annual Cost Burden (Dollars)	31,105	30,139	0	966	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: Two short partner feedback surveys (ICs) are being added to assess/improve CDC support and treatment information provided by CDC to public health partners.

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Annual Cost to Federal Government: $234,343

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.     Yes

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:  No

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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: 03/17/2022

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