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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
WHO Collaborating Laboratories Influenza Testing Methods Assessment	Form	Modified	Available
US WHO Colloborating Laboratories Influenza Testing Methods Assessment	Form	Modified	Repair queued
Arthropod (Vector)-Borne Diseases (Non-Human Data)	Form and Instruction	New	Available
Arthropod (Vector)-Borne Diseases (Non-Human Data)	Form and Instruction	New	Repair queued
Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Form (CRF)	Form and Instruction	New	Available
Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Form (CRF)	Form and Instruction	New	Repair queued
Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Short Form	Form and Instruction	New	Available
Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Short Form	Form and Instruction	New	Repair queued
Aggregate case counts of person exposed to Highly Pathogenic Avian Influenza (HPAI)	Form and Instruction	New	Available
Aggregate counts of persons exposed to Highly Pathogenic Avian Influenza (HPAI	Form and Instruction	New	Repair queued
Suspect Respiratory Virus Patient Form	Form	Modified	Available
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	Available
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 (MERS) Patient Under Investigation (PUI) Short Form	Form	Modified	Available
Middle East Respiratory Syndrome Coronavirus (MERS) Patient Under Investigation (PUI) Form	Form	Modified	Repair queued
National Adenovirus Type Reporting System (NATRS) Form	Form	Modified	Available
Adenovirus Typing Report Form	Form	Modified	Repair queued
Antiviral-Resistant Influenza Infection Case Report	Form	Modified	Available
Antiviral Resistant Influenza Infection Case Report Form	Form	Modified	Repair queued
Human Infection with Novel Influenza A Virus Severe Outcomes	Form	Modified	Available
Human Infections with Novel Influenza A Virus Severe Outcomes	Form	Modified	Repair queued
Form CDC 55.20 US Outpatient Influenza-like Illness Surveillance Network (ILINet) Weekly	Form	Removed	Available
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	Modified	Available
Influenza Associated Pediatric Mortality Case Report Form	Form	Modified	Repair queued
WHO Collaborating Center for Influenza Virus Surveillance	Form	Modified	Available
WHO Collaborating Center for Influenza Virus Surveillance	Form	Modified	Repair queued
Human Infection with Novel Influenza A Virus Case Report Form (addition of Suspected Avian Source)	Form	Modified	Available
Human Infection with Novel Influenza A Virus Case Report Form	Form	Modified	Repair queued
Novel Influenza A Virus Case Screening Form	Form	Modified	Available
Novel Influenza A Virus Case Screening Form	Form	Modified	Repair queued
Viral Gastroenteritis Outbreak Submission Form	Form	Modified	Available
Viral Gastroenteritis Outbreak Submission Form	Form	Modified	Repair queued
Form CDC 52.12 NORS - Waterborne Disease Transmission	Form	Removed	Available
Form CDC 52.12 Att Z_ Waterborne Diseases Transmission	Form	Removed	Repair queued
Form CDC 52.13 NORS - Foodborne, Person-to-Person, Animal Contact, Environmental Contamination, Unknown Transmission Mode	Form	Removed	Available
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 55.83B NREVSS Virus Isolation (culture) Worksheet	Form	Modified	Available
Form CDC 55.83D NREVSS Polymerase Chain Reaction (PCR) Worksheet	Form	Modified	Available
Form CDC 55.83A NREVSS Antigen Detection Worksheet	Form	Modified	Available
Form CDC 55.83A National Respiratory and Enteric Virus Surveillance System (NREVSS) Laboratory Assessment	Form	Modified	Repair queued
Form CDC 55.90 Enterovirus Surveillance System Report Form	Form	Modified	Available
Form CDC 55.90 National Enterovirus Surveillance Report 55.9	Form	Modified	Repair queued
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	Repair queued
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	Repair queued
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

Information collection document groups

IC ID	Collection	Type	Status	Form
37707	US WHO Colloborating Laboratories Influenza Testing Methods Assessment	Form	Modified	WHO Collaborating Laboratories Influenza Testing Methods Assessment
37707	US WHO Colloborating Laboratories Influenza Testing Methods Assessment	Form	Modified
258096	Arthropod (Vector)-Borne Diseases (Non-Human Data)	Form and Instruction	New	Arthropod (Vector)-Borne Diseases (Non-Human Data)
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	Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Form (CRF)
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	Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Short Form
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	Aggregate case counts of person exposed to Highly Pathogenic Avian Influenza (HPAI)
258093	Aggregate counts of persons exposed to Highly Pathogenic Avian Influenza (HPAI	Form and Instruction	New
228082	Suspect Respiratory Virus Patient Form	Form	Modified	Suspect Respiratory Virus Patient Form
228082	Suspect Respiratory Virus Patient Form	Form	Modified
228068	U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) Workfolder_CDC 55.20E	Form	Modified	U.S. Outpatient Influenza-Like Illness Surveillance Network (ILINet) - Workfolder_CDC 55.20E
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	Middle East Respiratory Syndrome (MERS) Patient Under Investigation (PUI) Short Form
212473	Middle East Respiratory Syndrome Coronavirus (MERS) Patient Under Investigation (PUI) Form	Form	Modified
212472	Adenovirus Typing Report Form	Form	Modified	National Adenovirus Type Reporting System (NATRS) Form
212472	Adenovirus Typing Report Form	Form	Modified
212471	Antiviral Resistant Influenza Infection Case Report Form	Form	Modified	Antiviral-Resistant Influenza Infection Case Report
212471	Antiviral Resistant Influenza Infection Case Report Form	Form	Modified
212470	Human Infections with Novel Influenza A Virus Severe Outcomes	Form	Modified	Human Infection with Novel Influenza A Virus Severe Outcomes
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	US Outpatient Influenza-like Illness Surveillance Network (ILINet) Weekly
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	Influenza-Associated Pediatric Mortality Case Report
199050	Influenza Associated Pediatric Mortality Case Report Form	Form	Modified
199049	WHO Collaborating Center for Influenza Virus Surveillance	Form	Modified	WHO Collaborating Center for Influenza Virus Surveillance
199049	WHO Collaborating Center for Influenza Virus Surveillance	Form	Modified
199043	Human Infection with Novel Influenza A Virus Case Report Form	Form	Modified	Human Infection with Novel Influenza A Virus Case Report Form (addition of Suspected Avian Source)
199043	Human Infection with Novel Influenza A Virus Case Report Form	Form	Modified
199040	Novel Influenza A Virus Case Screening Form	Form	Modified	Novel Influenza A Virus Case Screening Form
199040	Novel Influenza A Virus Case Screening Form	Form	Modified
178374	Viral Gastroenteritis Outbreak Submission Form	Form	Modified	Viral Gastroenteritis Outbreak Submission Form
178374	Viral Gastroenteritis Outbreak Submission Form	Form	Modified
178372	Att Z_ Waterborne Diseases Transmission	Form	Removed	NORS - Waterborne Disease Transmission
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	NORS - Foodborne, Person-to-Person, Animal Contact, Environmental Contamination, Unknown Transmission Mode
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	NREVSS Virus Isolation (culture) Worksheet
178365	National Respiratory and Enteric Virus Surveillance System (NREVSS) Laboratory Assessment	Form	Modified	NREVSS Polymerase Chain Reaction (PCR) Worksheet
178365	National Respiratory and Enteric Virus Surveillance System (NREVSS) Laboratory Assessment	Form	Modified	NREVSS Antigen Detection Worksheet
178365	National Respiratory and Enteric Virus Surveillance System (NREVSS) Laboratory Assessment	Form	Modified
178364	National Enterovirus Surveillance Report 55.9	Form	Modified	Enterovirus Surveillance System Report Form
178364	National Enterovirus Surveillance Report 55.9	Form	Modified

ICR Details

OMB Control No: 0920-0004	ICR Reference No: 202301-0920-009
Status: Historical Active	Previous ICR Reference No: 201707-0920-010
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-0004
Title: [NCIRD] National Disease Surveillance Program - II. Disease Summaries
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/27/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/27/2023
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2026	36 Months From Approved
Responses	134,983	0	0
Time Burden (Hours)	27,458	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: These data are essential on the local, state, and federal levels for measuring trends in diseases, evaluating the effectiveness of current preventive strategies, and determining the need to modify current preventive measures. The following diseases/conditions are included in this program: Influenza Virus, Caliciviruses, Respiratory and Enteric Viruses, Parechoviruses, Arthropod-Borne Diseases and Enteroviruses. CDC requests approval for a Reinstatement with Change of 0920-0004 National Disease Surveillance Program - II. Disease Summaries. Changes include addition of Forms, Discontinuation of Forms, and reformatting some questions. The overall result is a increase in Burden Hours and Respondents.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 56955	09/16/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 5358	01/27/2023
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 20

table that charts list of burden

IC Title	Form No.	Form Name
Adenovirus Typing Report Form	NA	National Adenovirus Type Reporting System (NATRS) Form
Aggregate counts of persons exposed to Highly Pathogenic Avian Influenza (HPAI	n/a	Aggregate case counts of person exposed to Highly Pathogenic Avian Influenza (HPAI)
Antiviral Resistant Influenza Infection Case Report Form	none	Antiviral-Resistant Influenza Infection Case Report
Arthropod (Vector)-Borne Diseases (Non-Human Data)	n/a	Arthropod (Vector)-Borne Diseases (Non-Human Data)
Att D_NORS Foodborne Disease Transmission_ Person to Person Disease Transmission_Animal Contact_Environmental Contamination_Unknown Transmission Mode	CDC 52.13	NORS - Foodborne, Person-to-Person, Animal Contact, Environmental Contamination, Unknown Transmission Mode
Att G US Outpatient Influenza-like Illness Surveillance Network (ILINet) Weekly	CDC 55.20	US Outpatient Influenza-like Illness Surveillance Network (ILINet) Weekly
Att Z_ Waterborne Diseases Transmission	CDC 52.12	NORS - Waterborne Disease Transmission
Human Infection with Novel Influenza A Virus Case Report Form	NA	Human Infection with Novel Influenza A Virus Case Report Form (addition of Suspected Avian Source)
Human Infections with Novel Influenza A Virus Severe Outcomes	None	Human Infection with Novel Influenza A Virus Severe Outcomes
Influenza Associated Pediatric Mortality Case Report Form	NA	Influenza-Associated Pediatric Mortality Case Report
Influenza Virus Electronic year round - PHLIP_HL7 Messaging Data Elements
Influenza Virus Electronic year round PHIN-MS
Middle East Respiratory Syndrome Coronavirus (MERS) Patient Under Investigation (PUI) Form	None	Middle East Respiratory Syndrome (MERS) Patient Under Investigation (PUI) Short Form
National Enterovirus Surveillance Report 55.9	CDC 55.90	Enterovirus Surveillance System Report Form
National Respiratory and Enteric Virus Surveillance System (NREVSS) Laboratory Assessment	CDC 55.83A, CDC 55.83D, CDC 55.83B	NREVSS Antigen Detection Worksheet ,   NREVSS Polymerase Chain Reaction (PCR) Worksheet ,   NREVSS Virus Isolation (culture) Worksheet
Novel Influenza A Virus Case Screening Form	None	Novel Influenza A Virus Case Screening Form
Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Form (CRF)	n/a	Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Form (CRF)
Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Short Form	n/a	Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Short Form
Suspect Respiratory Virus Patient Form	NA	Suspect Respiratory Virus Patient Form
U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) Workfolder_CDC 55.20E	CDC 55.20E	U.S. Outpatient Influenza-Like Illness Surveillance Network (ILINet) - Workfolder_CDC 55.20E
US WHO Colloborating Laboratories Influenza Testing Methods Assessment	NA	WHO Collaborating Laboratories Influenza Testing Methods Assessment
Viral Gastroenteritis Outbreak Submission Form	None	Viral Gastroenteritis Outbreak Submission Form
WHO Collaborating Center for Influenza Virus Surveillance	NA	WHO Collaborating Center for Influenza Virus Surveillance

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	134,983	0	0	97,468	-95,657	133,172
Annual Time Burden (Hours)	27,458	0	0	18,943	-16,286	24,801
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Four new forms were added and three were removed.

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Annual Cost to Federal Government: $10,955,594

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 01/27/2023

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