Information Collection

Cities - One time Addition of Diseases and Data Elements

IC 228451 under ICR 202205-0920-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Form 0920-0728 Disease-Specific Data Cities - One time Addition of Diseases and Data Elements	Form and Instruction
Att 5 - Core Data.xlsx	Instruction
Att 5 - Core Data.xlsx	Instruction
Att 6 - Laboratory Data.xlsx	Instruction
Att 6 - Laboratory Data.xlsx	Instruction
Att 8 - Vaccine Data.xlsx	Instruction
Att 8 - Vaccine Data.xlsx	Instruction
Att 9 - VPD Data.xlsx	Instruction
Att 9 - VPD Data.xlsx	Instruction
0920-0728 Disease-Specific Data Att 11 - Disease-Specific Data_CR_11022021.xlsx	Form and Instruction
0920-0728 Disease-Specific Data Att 11 - Disease-Specific Data_CR_11022021.xlsx	Form and Instruction
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
Att 5 - Laboratory Data_03172017.xlsx	IC Document
Att 5 - Laboratory Data_03172017.xlsx	IC Document
Att 9 - Justification for Disease-Specific Data.pdf Justification for Disease-Specific Data	IC Document
Att 9 - Justification for Disease-Specific Data.pdf Justification for Disease-Specific Data	IC Document
Att 15 - PRA Burden Statement Screenshot.pdf PRA Burden Statement (screenshot)	IC Document
Att 15 - PRA Burden Statement Screenshot.pdf PRA Burden Statement (screenshot)	IC Document

IC Title:

Cities - One time Addition of Diseases and Data Elements

Agency IC Tracking Number:

0920-0728

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	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction		Yes	Yes	Fillable Fileable
Instruction		Yes	Yes	Fillable Fileable
Instruction		Yes	Yes	Fillable Fileable
Instruction		Yes	Yes	Fillable Fileable
Form and Instruction	0920-0728	Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 09-20-0136 Epidemiologic Studies and Surveillance of Disease Problems

FR Citation: 76 FR 4458

Number of Respondents: 2

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	2	0	2
Annual IC Time Burden (Hours)	2	-30	32
Annual IC Cost Burden (Dollars)	1,387	0	1,387

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Justification for Disease-Specific Data		05/16/2022
PRA Burden Statement (screenshot)		05/16/2022
Attachment 4 Core Data		11/13/2013
Attachment 5 Disease-Specific Data		11/13/2013
		09/21/2015
		05/22/2017

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

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