Information Collection

57.115 Custom Event

IC 222891 under ICR 202408-0920-016 · OMB 0920-0666.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0666 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CDC 57.115 57.115 Custom Event	Form
CDC 57.115 Custom Event 57.115_CUS_November_2022.docx	Form
CDC 57.115 Custom Event 57.115_CUS_November_2022.docx	Form
57.115_CUS_November_2022.docx Custom Event with GISAB edits in tracked changes	IC Document
57.115_CUS_November_2022.docx Custom Event with GISAB edits in tracked changes	IC Document

IC Title:

57.115 Custom Event

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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
Form	CDC 57.115	Custom Event	57.115_CUS_November_2022.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 600

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	54,600	54,600
Annual IC Time Burden (Hours)	32,760	32,760
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Custom Event with GISAB edits in tracked changes	57.115_CUS_November_2022.docx	04/25/2023

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