Information Collection

Cluster Close-out Report

IC 236512 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Cluster Close-out Report	Form and Instruction
Cluster Close-out Form Cluster Close-out Report	Form and Instruction
Cluster Close-out Form Att 3g_Clean.docx	Form and Instruction
Cluster Close-out Form Att 3g_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

IC Title:

Cluster Close-out 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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	None				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 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	148	148
Annual IC Time Burden (Hours)	148	148
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Instructions for Completing the Cluster Report		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].