Information Collection

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

IC 235861 under ICR 202401-0920-012 · 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⚠️ Notice: This information collection may be referencing outdated material.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

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 7 - Vaccine Data.xlsx Instruction
Att 7 - Vaccine Data.xlsx Instruction
Att 8 - VPD Data.xlsx Instruction
Att 8 - VPD Data.xlsx Instruction
Att 10 - Disease-specific data_01222024.xlsx Instruction
Att 10 - Disease-specific data_01222024.xlsx Instruction

Information Collection (IC) Details

View Information Collection (IC)

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:

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 7 - Vaccine Data.xlsx	Yes	Yes	Fillable Fileable
Instruction	Att 8 - VPD Data.xlsx	Yes	Yes	Fillable Fileable
Instruction	Att 10 - Disease-specific data_01222024.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 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	3	0	3
Annual IC Time Burden (Hours)	9	-18	27
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.