Record Abstraction (STD Clinics)

[NCHHSTP] The STD Surveillance Network (SSuN)

Documents and Forms

Document Name Document Type
Form 0920-1072 Record Abstraction (STD Clinics) Form and Instruction
0920-1072 SSuN Data Elements Att5_DataElements_DataDisctionary.pdf Form and Instruction
0920-1072 SSuN Data Elements Att5_DataElements_DataDisctionary.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Record Abstraction (STD Clinics)	Agency IC Tracking Number:	0920-1072

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-1072	SSuN Data Elements	Att5_DataElements_DataDisctionary.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 40	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	240	229	11
Annual IC Time Burden (Hours)	960	696	264
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.