Information Collection

States - Weekly non-automated

IC 228438 under ICR 202209-0920-013 · 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⚠️ Notice: This information collection may be referencing outdated material.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 10 - Disease-Specific Data_CR_08022022.xlsx	Other-Data elements
Att 10 - Disease-Specific Data_CR_08022022.xlsx	Other-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
Attachment 5 Disease-Specific Data_12182014.xlsx	IC Document
Attachment 5 Disease-Specific Data_12182014.xlsx	IC Document
Att 4 - Core Data.xlsx	IC Document
Att 4 - Core Data.xlsx	IC Document

IC Title:

States - Weekly non-automated

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	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

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: 10

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	520	520
Annual IC Time Burden (Hours)	1,040	1,040
Annual IC Cost Burden (Dollars)	39,146	39,146

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
		01/05/2015
		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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