Information Collection

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

IC 235861 under ICR 202306-0920-004 · 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⚠️ Notice: This information collection may be referencing outdated material.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_2023.xlsx	Instruction
Att 5 - Core Data_2023.xlsx	Instruction
Att 6 - Laboratory Data_2023.xlsx	Instruction
Att 6 - Laboratory Data_2023.xlsx	Instruction
Att 7 - Vaccine Data_2023.xlsx	Instruction
Att 7 - Vaccine Data_2023.xlsx	Instruction
Att 8 - VPD Data_2023.xlsx	Instruction
Att 8 - VPD Data_2023.xlsx	Instruction
Att 10 - Disease-Specific Data_2023.xlsx	Instruction
Att 10 - Disease-Specific Data_2023.xlsx	Instruction
Att 10 - Disease-Specific Data_06012023.xlsx	Instruction
Att 10 - Disease-Specific Data_06012023.xlsx	Instruction

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction	Att 5 - Core Data_2023.xlsx		Yes	Yes	Fillable Fileable
Instruction	Att 6 - Laboratory Data_2023.xlsx		Yes	Yes	Fillable Fileable
Instruction	Att 7 - Vaccine Data_2023.xlsx		Yes	Yes	Fillable Fileable
Instruction	Att 8 - VPD Data_2023.xlsx		Yes	Yes	Fillable Fileable
Instruction	Att 10 - Disease-Specific Data_2023.xlsx		Yes	Yes	Fillable Fileable
Instruction	Att 10 - Disease-Specific Data_06012023.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: 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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	3	0	3
Annual IC Time Burden (Hours)	27	9	18
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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