Information Collection Request

[NCEZID] Oropouche Virus Disease Outbreak

ICR 202412-0920-003 · OMB 0920-1446 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 0920-1446 Sexual Contact Interview Form_04DEC2024 Form and Instruction Modified Available
Form 0920-25AU Sexual Contact Interview form Form and Instruction Modified Available
Form 0920-25AU Sexual Contact Interview form Form and Instruction Modified Repair queued
Form 0920-1446 Contact Tracing Survey_04DEC2024 Form Modified Available
Form 0920-25AU Contact Tracing Survey Form Modified Repair queued
Form 0920-25AU Contact Tracing Survey Form Modified Missing upstream
Form 0920-25AU Symptom Dairy Form Unchanged Repair queued
Form 0920-25AU Symptom Diary Form Unchanged Missing upstream
Form 0920-25AU FOLLOW-UP CLINICAL SURVEY Form and Instruction Unchanged Available
Form 0920-25AU Follow-up clinical survey Form and Instruction Unchanged Repair queued
Form 0920-1446 INITIAL CLINCAL AND SOCIAL SURVEY_04DEC2024 Form and Instruction Modified Repair queued
Form 0920-25AU INITIAL CLINCAL AND SOCIAL SURVEY Form and Instruction Modified Repair queued
Form 0920-25AU Baseline survey Form and Instruction Modified Missing upstream
Att A_Explanation for Program Changes_0920-1446_non-sub_29Nov2024.docx Supplementary Document Uploaded 2024-12-04 Repair queued
Att A_Explanation for Program Changes_0920-1446_non-sub_29Nov2024.docx Supplementary Document Uploaded 2024-12-04 Repair queued
0920-1446 Change Request-2024 Oropouche Response_11.29.2024.docx Justification for No Material/Nonsubstantive Change Uploaded 2024-12-04 Repair queued
0920-1446 Change Request-2024 Oropouche Response_11.29.2024.docx Justification for No Material/Nonsubstantive Change Uploaded 2024-12-04 Repair queued
Att. 13 Privacy Impact Assessment.pdf Supplementary Document Uploaded 2024-10-25 Repair queued
Att. 13 Privacy Impact Assessment.pdf Supplementary Document Uploaded 2024-10-25 Repair queued
Att. 13 Privacy Impact Assessment-2.pdf Supplementary Document Uploaded 2024-10-25 Available
Att. 13 Privacy Impact Assessment-2.pdf Supplementary Document Uploaded 2024-10-25 Missing upstream
Att. 12 Human Subjects Determination.pdf Supplementary Document Uploaded 2024-10-25 Available
Att. 12 Human Subjects Determination.pdf Supplementary Document Uploaded 2024-10-25 Missing upstream
Emergency Request Memo_OROV Response_10.25.24.docx Supplementary Document Uploaded 2024-10-25 Available
Emergency Request Memo_OROV Response_10.25.24.docx Supplementary Document Uploaded 2024-10-25 Missing upstream
Att. 11 Script and consent for sexual partner interview and OROV testing .docx Supplementary Document Uploaded 2024-10-24 Available
Att. 11 Script and consent for sexual partner interview and OROV testing .docx Supplementary Document Uploaded 2024-10-24 Repair queued
Att. 9 Consent for medical and social information .docx Supplementary Document Uploaded 2024-10-24 Available
Att. 9 Consent for medical and social information .docx Supplementary Document Uploaded 2024-10-24 Repair queued
Att. 8 Background information and frequently asked questions for participants .docx Supplementary Document Uploaded 2024-10-24 Repair queued
Att. 8 Background information and frequently asked questions for participants .docx Supplementary Document Uploaded 2024-10-24 Missing upstream
Supporting Statement B_OROV Response.docx Supporting Statement B Uploaded 2024-10-24 Repair queued
Supporting Statement B_OROV Response.docx Supporting Statement B Uploaded 2024-10-24 Missing upstream
Supporting Statement A_OROV Response_Revised.docx Supporting Statement A Uploaded 2024-10-24 Repair queued
Supporting Statement A_OROV Response_Revised.docx Supporting Statement A Uploaded 2024-10-24 Repair queued
Att. 1 Section 301 of the Public Health Service Act (42 USC 241).pdf Supplementary Document Uploaded 2024-10-24 Repair queued
Att. 1 Section 301 of the Public Health Service Act (42 USC 241).pdf Supplementary Document Uploaded 2024-10-24 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
271899 Sexual Contact Interview form Form and Instruction ModifiedSexual Contact Interview Form_04DEC2024
271899 Sexual Contact Interview form Form and Instruction ModifiedSexual Contact Interview form
271899 Sexual Contact Interview form Form and Instruction Modified
271898 Contact Tracing Survey Form ModifiedContact Tracing Survey_04DEC2024
271898 Contact Tracing Survey Form ModifiedContact Tracing Survey
271898 Contact Tracing Survey Form Modified
271897 Symptom Diary Form UnchangedSymptom Dairy
271897 Symptom Diary Form Unchanged
271896 Follow-up clinical survey Form and Instruction UnchangedFOLLOW-UP CLINICAL SURVEY
271896 Follow-up clinical survey Form and Instruction Unchanged
271895 Baseline survey Form and Instruction ModifiedINITIAL CLINCAL AND SOCIAL SURVEY_04DEC2024
271895 Baseline survey Form and Instruction ModifiedINITIAL CLINCAL AND SOCIAL SURVEY
271895 Baseline survey Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
03/31/2025 03/31/2025 03/31/2025
2,850 0 2,850
663 0 663
0 0 0





Reginfo record details
5
table that charts list of burden
IC Title Form No. Form Name
Baseline survey 0920-25AU, 0920-1446 ,  
Contact Tracing Survey 0920-25AU, 0920-1446 ,  
Follow-up clinical survey 0920-25AU
Sexual Contact Interview form 0920-25AU, 0920-1446 ,  
Symptom Diary 0920-25AU

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 2,850 2,850 0 0 0 0
Annual Time Burden (Hours) 663 663 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No