Information Collection

Component 3 - STLT Health Dept Case Data

IC 263102 under ICR 202310-0920-009 · OMB 0920-1422.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment-10_Component-3_NWSS_DCIPHER_CaseData_CSV_Upload_Template.csv	Other-Template
Attachment-10_Component-3_NWSS_DCIPHER_CaseData_CSV_Upload_Template.csv	Other-Template
Attachment-11_Component-3_NWSS_DCIPHER_SewershedName_Crosswalk_CSV_Upload_Template.csv	Other-Template
Attachment-11_Component-3_NWSS_DCIPHER_SewershedName_Crosswalk_CSV_Upload_Template.csv	Other-Template
Attachment-07_Component-1-2-3_ref-NWSS_DCIPHER_BulkUploadTool_screenshot.pdf NWSS Bulk Upload Tool - screenshot	IC Document
Attachment-07_Component-1-2-3_ref-NWSS_DCIPHER_BulkUploadTool_screenshot.pdf NWSS Bulk Upload Tool - screenshot	IC Document
Attachment-08_Component-3_ref-NWSS COVID Case Data Dictionary_v1_0_0.xlsx NWSS COVID Case Data Dictionary	IC Document
Attachment-08_Component-3_ref-NWSS COVID Case Data Dictionary_v1_0_0.xlsx NWSS COVID Case Data Dictionary	IC Document

IC Title:

Agency IC Tracking Number:

0920-23GL

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Template			Attachment-10_Component-3_NWSS_DCIPHER_CaseData_CSV_Upload_Template.csv		Yes	Yes	Fillable Fileable
Other-Template			Attachment-11_Component-3_NWSS_DCIPHER_SewershedName_Crosswalk_CSV_Upload_Template.csv		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 55

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
Annual Number of Responses for this IC	3,664,595	3,664,595
Annual IC Time Burden (Hours)	305,383	305,383
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
NWSS Bulk Upload Tool - screenshot	Attachment-07_Component-1-2-3_ref-NWSS_DCIPHER_BulkUploadTool_screenshot.pdf	10/30/2023
NWSS COVID Case Data Dictionary	Attachment-08_Component-3_ref-NWSS COVID Case Data Dictionary_v1_0_0.xlsx	10/30/2023

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