OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

[NCIRD] National Disease Surveillance Program - II. Disease Summaries

ICR 202301-0920-009 · OMB 0920-0004 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
US WHO Colloborating Laboratories Influenza Testing Methods Assessment Form Modified Missing upstream
Arthropod (Vector)-Borne Diseases (Non-Human Data) Form and Instruction New Missing upstream
Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Form (CRF) Form and Instruction New Missing upstream
Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Short Form Form and Instruction New Missing upstream
Aggregate counts of persons exposed to Highly Pathogenic Avian Influenza (HPAI Form and Instruction New Repair queued
Suspect Respiratory Virus Patient Form Form Modified Repair queued
Form CDC 55.20E U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) Workfolder_CDC 55.20E Form Modified Repair queued
Middle East Respiratory Syndrome Coronavirus (MERS) Patient Under Investigation (PUI) Form Form Modified Missing upstream
Adenovirus Typing Report Form Form Modified Repair queued
Antiviral Resistant Influenza Infection Case Report Form Form Modified Repair queued
Human Infections with Novel Influenza A Virus Severe Outcomes Form Modified Repair queued
Form CDC 55.20 Att G US Outpatient Influenza-like Illness Surveillance Network (ILINet) Weekly Form Removed Repair queued
Influenza Associated Pediatric Mortality Case Report Form Form Modified Repair queued
WHO Collaborating Center for Influenza Virus Surveillance Form Modified Repair queued
Human Infection with Novel Influenza A Virus Case Report Form Form Modified Repair queued
Novel Influenza A Virus Case Screening Form Form Modified Repair queued
Viral Gastroenteritis Outbreak Submission Form Form Modified Repair queued
Form CDC 52.12 Att Z_ Waterborne Diseases Transmission Form Removed Missing upstream
Form CDC 52.13 Att D_NORS Foodborne Disease Transmission_ Person to Person Disease Transmission_Animal Contact_Environmental Contamination_Unknown Transmission Mode Form Removed Repair queued
Form CDC 55.83A National Respiratory and Enteric Virus Surveillance System (NREVSS) Laboratory Assessment Form Modified Repair queued
Form CDC 55.90 National Enterovirus Surveillance Report 55.9 Form Modified Missing upstream
Attachment DD 103122NL-NR.pdf Supplementary Document Uploaded 2023-01-26 Repair queued
Attachment C_Disease Summaries 0920-0004 _2023 FINAL_final.docx Supplementary Document Uploaded 2023-01-26 Missing upstream
Attachment B 60 Day Federal Register Notice.pdf Supplementary Document Uploaded 2023-01-26 Repair queued
Authorizing Legislation.pdf Supplementary Document Uploaded 2023-01-26 Missing upstream
SSB 0920-0004 REINSTATEMENT 2023 FINAL.docx Supporting Statement B Uploaded 2023-01-26 Repair queued
SSA 0920-0004 REINSTATEMENT 2023 FINAL_final.docx Supporting Statement A Uploaded 2023-01-26 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
37707 US WHO Colloborating Laboratories Influenza Testing Methods Assessment Form Modified
258096 Arthropod (Vector)-Borne Diseases (Non-Human Data) Form and Instruction New
258095 Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Form (CRF) Form and Instruction New
258094 Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Short Form Form and Instruction New
258093 Aggregate counts of persons exposed to Highly Pathogenic Avian Influenza (HPAI Form and Instruction New
228082 Suspect Respiratory Virus Patient Form Form Modified
228068 U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) Workfolder_CDC 55.20E Form Modified
212473 Middle East Respiratory Syndrome Coronavirus (MERS) Patient Under Investigation (PUI) Form Form Modified
212472 Adenovirus Typing Report Form Form Modified
212471 Antiviral Resistant Influenza Infection Case Report Form Form Modified
212470 Human Infections with Novel Influenza A Virus Severe Outcomes Form Modified
199056 Att G US Outpatient Influenza-like Illness Surveillance Network (ILINet) Weekly Form Removed
199052 Influenza Virus Electronic year round PHIN-MS Other-Variables for Reporting Modified
199051 Influenza Virus Electronic year round - PHLIP_HL7 Messaging Data Elements Other-Variables for Electronic Reporting Modified
199050 Influenza Associated Pediatric Mortality Case Report Form Form Modified
199049 WHO Collaborating Center for Influenza Virus Surveillance Form Modified
199043 Human Infection with Novel Influenza A Virus Case Report Form Form Modified
199040 Novel Influenza A Virus Case Screening Form Form Modified
178374 Viral Gastroenteritis Outbreak Submission Form Form Modified
178372 Att Z_ Waterborne Diseases Transmission Form Removed
178369 Att D_NORS Foodborne Disease Transmission_ Person to Person Disease Transmission_Animal Contact_Environmental Contamination_Unknown Transmission Mode Form Removed
178365 National Respiratory and Enteric Virus Surveillance System (NREVSS) Laboratory Assessment Form Modified
178364 National Enterovirus Surveillance Report 55.9 Form Modified
ICR Details
StatusReceived in OIRA
Agency/SubagencyHHS/CDC
OMB Control No0920-0004
Type of Information CollectionReinstatement with change of a previously approved collection
Previous ICR Reference No201707-0920-010
Agency Tracking No0920-0004
Date Submitted to OIRA1969-12-31
Requested Expiration Date1969-12-31