Information Collection

Territories - Weekly, quarterly - non-automated

IC 228442 under ICR 202504-0920-009 · OMB 0920-0728.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att 6 - Core Data.xlsx	Other-Data elements
Att 6 - Core Data.xlsx	Other-Data elements
Att 7 - Laboratory Data.xlsx	Other-Data elements
Att 7 - Laboratory Data.xlsx	Other-Data elements
Att 8 - Vaccine Data.xlsx	Other-Data elements
Att 8 - Vaccine Data.xlsx	Other-Data elements
Att 9 - VPD Data.xlsx	Other-Data elements
Att 9 - VPD Data.xlsx	Other-Data elements
Att 11 - Disease-specific data.xlsx	Other-Data elements
Att 11 - Disease-specific data_REV 08272025.xlsx	Other-Data elements
Attachment 4 Core Data.xlsx Attachment 4 Core Data	IC Document
Attachment 4 Core Data.xlsx Attachment 4 Core Data	IC Document
Attachment 5 Disease-Specific Data.xlsx Attachment 5 Disease-Specific Data	IC Document
Attachment 5 Disease-Specific Data.xlsx Attachment 5 Disease-Specific Data	IC Document
Att 4 - Core Data.xlsx	IC Document
Att 4 - Core Data.xlsx	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Data elements		Yes	Yes	Fillable Fileable
Other-Data elements		Yes	Yes	Fillable Fileable
Other-Data elements		Yes	Yes	Fillable Fileable
Other-Data elements		Yes	Yes	Fillable Fileable
Other-Data elements	N/A	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: 5

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	Previously Approved
Annual Number of Responses for this IC	280	280
Annual IC Time Burden (Hours)	93	93
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 4 Core Data		11/13/2013
Attachment 5 Disease-Specific Data		11/13/2013
		09/21/2015

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

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].