Information Collection

Cluster Follow-up Report

IC 236511 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⚠️ Notice: This information collection may be referencing outdated material.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:

Documents and Forms

Document Name Document Type
Cluster Follow-up Report Form and Instruction
Cluster Follow-up Form Cluster Follow-up Report Form and Instruction
Cluster Follow-up Form Att 3f_Clean.docx Form and Instruction
Cluster Follow-up Form Att 3f_Clean.docx Form and Instruction
Att_4(f) Cluster Report Form Instructions updated 11052021_share.pdf Instructions for Completing the Cluster Report IC Document
Att_4(f) Cluster Report Form Instructions updated 11052021_share.pdf Instructions for Completing the Cluster Report IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Cluster Follow-up Report	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	None	Cluster Follow-up Form	Att 3f_Clean.docx		Yes	Yes	Fillable Fileable

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 %

	Approved	Previously Approved
Annual Number of Responses for this IC	295	295
Annual IC Time Burden (Hours)	148	148
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Instructions for Completing the Cluster Report	Att_4(f) Cluster Report Form Instructions updated 11052021_share.pdf	09/08/2022

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].