Information Collection Request

[NCEZID] CryptoNet Case Report Form

ICR 202412-0920-011 · OMB 0920-1360 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
CryptoNet Case Report Form Form and Instruction Modified Repair queued
CryptoNet Case Report Form Form and Instruction Modified Repair queued
Att E2_Privacy Impact Assessment.pdf Supplementary Document Uploaded 2024-12-17 Repair queued
Att E2_Privacy Impact Assessment.pdf Supplementary Document Uploaded 2024-12-17 Missing upstream
Att E_Privacy Impact Assessment_DCIPHER SaaS.pdf Supplementary Document Uploaded 2024-12-17 Repair queued
Att E_Privacy Impact Assessment_DCIPHER SaaS.pdf Supplementary Document Uploaded 2024-12-17 Repair queued
Att D_Human Subjects Determination.pdf Supplementary Document Uploaded 2024-12-17 Repair queued
Att D_Human Subjects Determination.pdf Supplementary Document Uploaded 2024-12-17 Repair queued
Att B_ Published Federal Register Notice.pdf Supplementary Document Uploaded 2024-12-17 Repair queued
Att B_ Published Federal Register Notice.pdf Supplementary Document Uploaded 2024-12-17 Missing upstream
Att A_Section 301 of the Public Health Service Act (42 USC 241) (1) (1) (1).pdf Supplementary Document Uploaded 2024-12-17 Repair queued
Att A_Section 301 of the Public Health Service Act (42 USC 241) (1) (1) (1).pdf Supplementary Document Uploaded 2024-12-17 Repair queued
SSB_CryptoNet_2024 revision package - CLEAN.docx Supporting Statement B Uploaded 2024-12-17 Repair queued
SSB_CryptoNet_2024 revision package - CLEAN.docx Supporting Statement B Uploaded 2024-12-17 Missing upstream
SSA_CryptoNet_2024 revision package_CLEAN_final.docx Supporting Statement A Uploaded 2025-02-25 Repair queued
SSA_CryptoNet_2024 revision package_CLEAN_final.docx Supporting Statement A Uploaded 2024-12-23 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
248663 CryptoNet Case Report Form Form and Instruction ModifiedCryptoNet Case Report Form
248663 CryptoNet Case Report Form Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
02/29/2028 36 Months From Approved 02/28/2025
500 0 500
125 0 125
0 0 3,215





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
CryptoNet Case Report Form n/a

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 500 500 0 0 0 0
Annual Time Burden (Hours) 125 125 0 0 0 0
Annual Cost Burden (Dollars) 0 3,215 0 -3,215 0 0


Reginfo record details
  No