Information Collection

Cities - One time Addition of Diseases and Data Elements

IC 228451 under ICR 202208-0920-005 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
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 10 - Disease-Specific Data_CR_08022022.xlsx Form and Instruction
0920-0728 Disease-Specific Data Att 10 - Disease-Specific Data_CR_08022022.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

Information Collection (IC) Details

View Information Collection (IC)

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:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Att 5 - Core Data.xlsx	Yes	Yes	Fillable Fileable
Instruction			Att 6 - Laboratory Data.xlsx	Yes	Yes	Fillable Fileable
Instruction			Att 8 - Vaccine Data.xlsx	Yes	Yes	Fillable Fileable
Instruction			Att 9 - VPD Data.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0728	Disease-Specific Data	Att 10 - Disease-Specific Data_CR_08022022.xlsx	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 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2	0	2
Annual IC Time Burden (Hours)	8	6	2
Annual IC Cost Burden (Dollars)	1,387	0	1,387

Documents for IC

Title	Document	Date Uploaded
Justification for Disease-Specific Data	Att 9 - Justification for Disease-Specific Data.pdf	05/16/2022
PRA Burden Statement (screenshot)	Att 15 - PRA Burden Statement Screenshot.pdf	05/16/2022
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
	Att 5 - Laboratory Data_03172017.xlsx	05/22/2017

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