Information Collection

Freely Associated States - One-time Addition of Diseases and Data Elements

IC 235861 under ICR 202302-0920-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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 8 - Vaccine Data.xlsx	Instruction
Att 8 - Vaccine Data.xlsx	Instruction
Att 8 - VPD Data.xlsx	Instruction
Att 8 - VPD Data.xlsx	Instruction
Att 10 - Disease-Specific Data_CR_02012023.xlsx	Instruction
Att 10 - Disease-Specific Data_CR_02012023.xlsx	Instruction
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:

Freely Associated 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	Instrument File	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 8 - Vaccine Data.xlsx	Yes	Yes	Fillable Fileable
Instruction	Att 8 - VPD Data.xlsx	Yes	Yes	Fillable Fileable
Instruction	Att 10 - Disease-Specific Data_CR_02012023.xlsx	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: 3

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	3	3
Annual IC Time Burden (Hours)	13	13
Annual IC Cost Burden (Dollars)	2,080	2,080

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	05/16/2022
PRA Burden Statement (screenshot)	Att 15 - PRA Burden Statement Screenshot.pdf	05/16/2022

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