Information Collection

Investigation of Multistate Outbreak of Severe Illness related to consumption of Diamond ShruumzTM Brand products-United States_2024

IC 269133 under ICR 202209-0920-030 · OMB 0920-1011.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1011 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1011 Diamond Shruumz Outbreak Investigation Case Report Form Investigation of Multistate Outbreak of Severe Illness related to consumption of Diamond ShruumzTM Brand products-United States_2024	Form and Instruction
0920-1011 Diamond Shruumz Outbreak Investigation Case Report Form Appx1 Protocol for Case Report and Investig QRE for Diamond Shruumz Outbreak Investig_Final.pdf	Form and Instruction
1. GenIC Request Form - EEI Generic ICR_DiamondShruumz_Final.docx 0920-1011 EEI GenIC Request Memo	IC Document
0920-1011 - Burden Estimate Email.msg Burden Estimate Memo	IC Document
CSTE Letter to Dr Erik Svendsen - NCEH.pdf CSTE Letter of Support	IC Document
AZ Letter of Support 20240625.NCEH.pdf Letter of Invitation - Sample_AZ	IC Document
NV Letter of Support for coordinated investigation support NCEH Outbreak 2024-06-24.pdf Letter of Invitation - Sample_NV	IC Document
CDCMemo_EEI_DiamondShruumz AC 7-3-2024.pdf CDC Memo EEI Diamond Shruumz	IC Document

IC Title:

Investigation of Multistate Outbreak of Severe Illness related to consumption of Diamond ShruumzTM Brand products-United States_2024

Agency IC Tracking Number:

0920-1011

IC Status: New

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
Form and Instruction	0920-1011			N/A	Yes	Yes	Fillable Fileable

Line of Business: Disaster Management

Subfunction: Emergency Response

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	83	83
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
0920-1011 EEI GenIC Request Memo		07/03/2024
Burden Estimate Memo		07/03/2024
CSTE Letter of Support		07/03/2024
Letter of Invitation - Sample_AZ		07/03/2024
Letter of Invitation - Sample_NV		07/03/2024
CDC Memo EEI Diamond Shruumz		07/05/2024

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

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].