Information Collection

States - One time addition of diseases and data elements

IC 228441 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⚠️ Notice: This information collection may be referencing outdated material.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.xlsx	Instruction
Att 5 - Core Data.xlsx	Instruction
Att 6 - Laboratory Data.xlsx	Instruction
Att 6 - Laboratory Data.xlsx	Instruction
Att 7 - Vaccine Data.xlsx	Instruction
Att 7 - Vaccine Data.xlsx	Instruction
Att 8 - VPD Data.xlsx	Instruction
Att 8 - VPD Data.xlsx	Instruction
Att 10 - Disease-Specific Data_CR_09152022.xlsx	Instruction
Att 10 - Disease-Specific Data_CR_09152022.xlsx	Instruction
0920-0728 Disease-Specific Data Elements Att 10 - Disease-Specific Data_CR_08022022.xlsx	Form
0920-0728 Disease-Specific Data Elements Att 10 - Disease-Specific Data_CR_08022022.xlsx	Form
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
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:

States - 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.	Form Name	Instrument File	URL	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 7 - Vaccine Data.xlsx		Yes	Yes	Fillable Fileable
Instruction			Att 8 - VPD Data.xlsx		Yes	Yes	Fillable Fileable
Form	0920-0728	Disease-Specific Data Elements	Att 10 - Disease-Specific Data_CR_08022022.xlsx		Yes	Yes	Printable Only
Instruction			Att 10 - Disease-Specific Data_CR_09152022.xlsx	NA	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: 50

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	50	0	50
Annual IC Time Burden (Hours)	217	17	200
Annual IC Cost Burden (Dollars)	34,673	0	34,673

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Justification for Disease-Specific Data	Att 9 - Justification for Disease-Specific Data.pdf	05/11/2022
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
	Attachment 5 Disease-Specific Data_12182014.xlsx	01/05/2015
	Att 4 - Core Data.xlsx	09/21/2015

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