Information Collection

Annual Reporting: Standards Evaluation Report (SER)

IC 220109 under ICR 202508-0920-010 · OMB 0920-0573.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0573 can be found here:

2026-02-23 - Extension without change of a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0573 Annual Reporting: Standards Evaluation Report (SER)	Form and Instruction
Form 0920-0573 2024 Standards Evaluation Report (SER) Surveillance Program Performance Annual Reporting: Standards Evaluation Report (SER)	Form and Instruction
Form 0920-0573-24HX Standards Evaluation Report (SER) " Surveillance Program Performance" Annual Reporting: Standards Evaluation Report (SER)	Form
Form 0920-0573 NHSS - Standards Evaluation Report (SER) Form 29AUG2025 Annual Reporting: Standards Evaluation Report (SER)	Form and Instruction
0920-0573 2024 Standards Evaluation Report (SER) Surveillance Prog Att3d SER PS18-1802_2024.pdf	Form and Instruction
0920-0573 2024 Standards Evaluation Report (SER) Surveillance Prog Att3d SER PS18-1802_2024.pdf	Form and Instruction
0920-0573-24HX Standards Evaluation Report (SER) " Surveillance Program Att 3d_Standards Evaluation Report Form (SER)_clean.docx	Form
0920-0573-24HX Standards Evaluation Report (SER) " Surveillance Program Att 3d_Standards Evaluation Report Form (SER)_clean.docx	Form
0920-0573 NHSS - Standards Evaluation Report (SER) Form 29AUG2025 Att_3d SER PS24-0047_clean.pdf	Form and Instruction
0920-0573 NHSS - Standards Evaluation Report (SER) Form 29AUG2025 Att_3d SER PS24-0047_clean.pdf	Form and Instruction
Att 2 SER PS18-1802_2024_track changes.docx Att 2_SER 2024 (track changes)	IC Document
Att 2 SER PS18-1802_2024_track changes.docx Att 2_SER 2024 (track changes)	IC Document
Att 3d_SER (WORD)_rev. 2024.docx Att 3d_ SER (WORD) rev.2024	IC Document
Att 3d_SER (WORD)_rev. 2024.docx Att 3d_ SER (WORD) rev.2024	IC Document
Att 3d_Standards Evaluation Report Form (SER)_tracked.docx Standard Evaluation Report (track changes) 24HX	IC Document
Att 3d_Standards Evaluation Report Form (SER)_tracked.docx Standard Evaluation Report (track changes) 24HX	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Annual Reporting: Standards Evaluation Report (SER)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-0573		Yes	Yes	Fillable Fileable
Form	0920-0573-24HX		Yes	Yes	Fillable Fileable
Form and Instruction	0920-0573	N/A	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: SORN 09-20-0136, Epidemiologic Studies and Surveillance of Disease Problems HHS/CDC

FR Citation: 57 FR 62812

Number of Respondents: 59

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	59	59
Annual IC Time Burden (Hours)	472	472
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att 2_SER 2024 (track changes)		10/17/2023
Att 3d_ SER (WORD) rev.2024		10/17/2023
Standard Evaluation Report (track changes) 24HX		08/05/2024

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

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