Information Collection

Syndromic Surveillance Report

IC 277518 under ICR 202509-0920-002 · OMB 0920-1368.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Syndromic Surveillance Report	Form and Instruction
Syndromic Surveillance Report Syndromic Surveillance Report	Form and Instruction
Syndromic Surveillance Report Att F 0920-1368 CSP Syn Surv Rpt.docx	Form and Instruction
Syndromic Surveillance Report Att F 0920-1368 CSP Syn Surv Rpt.docx	Form and Instruction
Att F1 0920-1368 CSP SynSurRpt Screenshots.docx Syndromic Surveillance Report (screenshots)	IC Document
Att F1 0920-1368 CSP SynSurRpt Screenshots.docx Syndromic Surveillance Report (screenshots)	IC Document

IC Title:

Agency IC Tracking Number:

0920-1368

Is this a Common Form? No

IC Status: New

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	n/a				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 24

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	96	96
Annual IC Time Burden (Hours)	192	192
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Syndromic Surveillance Report (screenshots)		09/11/2025

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

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