[NCIRD] National Disease Surveillance Program - II. Disease Summaries

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
WHO Collaborating Laboratories Influenza Testing Methods Assessment	Form	Unchanged	Available
US WHO Colloborating Laboratories Influenza Testing Methods Assessment	Form	Unchanged	Repair queued
Arthropod (Vector)-Borne Diseases (Non-Human Data)	Form and Instruction	Unchanged	Available
Arthropod (Vector)-Borne Diseases (Non-Human Data)	Form and Instruction	Unchanged	Missing upstream
Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Form (CRF)	Form and Instruction	Unchanged	Available
Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Form (CRF)	Form and Instruction	Unchanged	Repair queued
Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Short Form	Form and Instruction	Unchanged	Available
Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Short Form	Form and Instruction	Unchanged	Repair queued
Form 0920-0004 Aggregate counts of persons exposed to highly pathogenic avian influenza HPAI_06MAY2024	Form and Instruction	Unchanged	Available
Aggregate case counts of person exposed to Highly Pathogenic Avian Influenza (HPAI)	Form and Instruction	Unchanged	Available
Aggregate counts of persons exposed to Highly Pathogenic Avian Influenza (HPAI	Form and Instruction	Unchanged	Repair queued
Suspect Respiratory Virus Patient Form	Form	Unchanged	Available
Suspect Respiratory Virus Patient Form	Form	Unchanged	Repair queued
Form CDC 55.20E U.S. Outpatient Influenza-Like Illness Surveillance Network (ILINet) - Workfolder_CDC 55.20E	Form	Unchanged	Available
Form CDC 55.20E U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) Workfolder_CDC 55.20E	Form	Unchanged	Repair queued
Middle East Respiratory Syndrome (MERS) Patient Under Investigation (PUI) Short Form	Form	Unchanged	Available
Middle East Respiratory Syndrome Coronavirus (MERS) Patient Under Investigation (PUI) Form	Form	Unchanged	Repair queued
Form 0920-26-0003 National Adenovirus Type Reporting System (NATRS) Form	Form	Modified	Available
Form 0920-26-0003 Adenovirus Typing Report Form	Form	Modified	Repair queued
Antiviral-Resistant Influenza Infection Case Report	Form	Unchanged	Available
Antiviral Resistant Influenza Infection Case Report Form	Form	Unchanged	Repair queued
Human Infection with Novel Influenza A Virus Severe Outcomes	Form	Unchanged	Available
Human Infections with Novel Influenza A Virus Severe Outcomes	Form	Unchanged	Repair queued
Influenza-Associated Pediatric Mortality Case Report	Form	Unchanged	Repair queued
Influenza Associated Pediatric Mortality Case Report Form	Form	Unchanged	Repair queued
WHO Collaborating Center for Influenza Virus Surveillance	Form	Unchanged	Available
WHO Collaborating Center for Influenza Virus Surveillance	Form	Unchanged	Repair queued
Form 0920-0004 Human Infection with Novel Influenza A Virus Case Report Form 06MAY2024	Form and Instruction	Unchanged	Available
Human Infection with Novel Influenza A Virus Case Report Form (addition of Suspected Avian Source)	Form	Unchanged	Available
Human Infection with Novel Influenza A Virus Case Report Form	Form	Unchanged	Repair queued
Form 0920-0004 Novel Influenza A Virus Case Screening Form 06MAY2024	Form and Instruction	Unchanged	Available
Novel Influenza A Virus Case Screening Form	Form	Unchanged	Available
Novel Influenza A Virus Case Screening Form	Form	Unchanged	Repair queued
Viral Gastroenteritis Outbreak Submission Form	Form	Unchanged	Available
Viral Gastroenteritis Outbreak Submission Form	Form	Unchanged	Repair queued
Form CDC 55.83B NREVSS Virus Isolation (culture) Worksheet	Form	Unchanged	Available
Form CDC 55.83D NREVSS Polymerase Chain Reaction (PCR) Worksheet	Form	Unchanged	Available
Form CDC 55.83A NREVSS Antigen Detection Worksheet	Form	Unchanged	Available
Form CDC 55.83A National Respiratory and Enteric Virus Surveillance System (NREVSS) Laboratory Assessment	Form	Unchanged	Missing upstream
Form CDC 55.90 Enterovirus Surveillance System Report Form	Form	Unchanged	Available
Form CDC 55.90 National Enterovirus Surveillance Report 55.9	Form	Unchanged	Repair queued
Change Request Memo - EO14168 Template_20251201 (1).docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-12-08	Repair queued
Change Request Memo - EO14168 Template_20251201 (1).docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-12-08	Repair queued
ICR Change request memo_OMB 0920-0004 20240503.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2024-05-06	Available
ICR Change request memo_OMB 0920-0004 20240503.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2024-05-06	Missing upstream
Attachment DD 103122NL-NR.pdf	Supplementary Document	Uploaded 2023-01-26	Available
Attachment DD 103122NL-NR.pdf	Supplementary Document	Uploaded 2023-01-26	Repair queued
Attachment C_Disease Summaries 0920-0004 _2023 FINAL_final.docx	Supplementary Document	Uploaded 2023-01-26	Available
Attachment C_Disease Summaries 0920-0004 _2023 FINAL_final.docx	Supplementary Document	Uploaded 2023-01-26	Repair queued
Attachment B 60 Day Federal Register Notice.pdf	Supplementary Document	Uploaded 2023-01-26	Available
Attachment B 60 Day Federal Register Notice.pdf	Supplementary Document	Uploaded 2023-01-26	Repair queued
Authorizing Legislation.pdf	Supplementary Document	Uploaded 2023-01-26	Available
Authorizing Legislation.pdf	Supplementary Document	Uploaded 2023-01-26	Repair queued
SSB 0920-0004 REINSTATEMENT 2023 FINAL.docx	Supporting Statement B	Uploaded 2023-01-26	Available
SSB 0920-0004 REINSTATEMENT 2023 FINAL.docx	Supporting Statement B	Uploaded 2023-01-26	Repair queued
SSA 0920-0004 REINSTATEMENT 2023 FINAL_final.docx	Supporting Statement A	Uploaded 2023-01-26	Available
SSA 0920-0004 REINSTATEMENT 2023 FINAL_final.docx	Supporting Statement A	Uploaded 2023-01-26	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
37707	US WHO Colloborating Laboratories Influenza Testing Methods Assessment	Form	Unchanged	WHO Collaborating Laboratories Influenza Testing Methods Assessment
37707	US WHO Colloborating Laboratories Influenza Testing Methods Assessment	Form	Unchanged
258096	Arthropod (Vector)-Borne Diseases (Non-Human Data)	Form and Instruction	Unchanged	Arthropod (Vector)-Borne Diseases (Non-Human Data)
258096	Arthropod (Vector)-Borne Diseases (Non-Human Data)	Form and Instruction	Unchanged
258095	Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Form (CRF)	Form and Instruction	Unchanged	Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Form (CRF)
258095	Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Form (CRF)	Form and Instruction	Unchanged
258094	Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Short Form	Form and Instruction	Unchanged	Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Short Form
258094	Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Short Form	Form and Instruction	Unchanged
258093	Aggregate counts of persons exposed to Highly Pathogenic Avian Influenza (HPAI	Form and Instruction	Unchanged	Aggregate counts of persons exposed to highly pathogenic avian influenza HPAI_06MAY2024
258093	Aggregate counts of persons exposed to Highly Pathogenic Avian Influenza (HPAI	Form and Instruction	Unchanged	Aggregate case counts of person exposed to Highly Pathogenic Avian Influenza (HPAI)
258093	Aggregate counts of persons exposed to Highly Pathogenic Avian Influenza (HPAI	Form and Instruction	Unchanged
228082	Suspect Respiratory Virus Patient Form	Form	Unchanged	Suspect Respiratory Virus Patient Form
228082	Suspect Respiratory Virus Patient Form	Form	Unchanged
228068	U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) Workfolder_CDC 55.20E	Form	Unchanged	U.S. Outpatient Influenza-Like Illness Surveillance Network (ILINet) - Workfolder_CDC 55.20E
228068	U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) Workfolder_CDC 55.20E	Form	Unchanged
212473	Middle East Respiratory Syndrome Coronavirus (MERS) Patient Under Investigation (PUI) Form	Form	Unchanged	Middle East Respiratory Syndrome (MERS) Patient Under Investigation (PUI) Short Form
212473	Middle East Respiratory Syndrome Coronavirus (MERS) Patient Under Investigation (PUI) Form	Form	Unchanged
212472	Adenovirus Typing Report Form	Form	Modified	National Adenovirus Type Reporting System (NATRS) Form
212472	Adenovirus Typing Report Form	Form	Modified
212471	Antiviral Resistant Influenza Infection Case Report Form	Form	Unchanged	Antiviral-Resistant Influenza Infection Case Report
212471	Antiviral Resistant Influenza Infection Case Report Form	Form	Unchanged
212470	Human Infections with Novel Influenza A Virus Severe Outcomes	Form	Unchanged	Human Infection with Novel Influenza A Virus Severe Outcomes
212470	Human Infections with Novel Influenza A Virus Severe Outcomes	Form	Unchanged
199052	Influenza Virus Electronic year round PHIN-MS	Other-Variables for Reporting	Unchanged
199051	Influenza Virus Electronic year round - PHLIP_HL7 Messaging Data Elements	Other-Variables for Electronic Reporting	Unchanged
199050	Influenza Associated Pediatric Mortality Case Report Form	Form	Unchanged	Influenza-Associated Pediatric Mortality Case Report
199050	Influenza Associated Pediatric Mortality Case Report Form	Form	Unchanged
199049	WHO Collaborating Center for Influenza Virus Surveillance	Form	Unchanged	WHO Collaborating Center for Influenza Virus Surveillance
199049	WHO Collaborating Center for Influenza Virus Surveillance	Form	Unchanged
199043	Human Infection with Novel Influenza A Virus Case Report Form	Form and Instruction	Unchanged	Human Infection with Novel Influenza A Virus Case Report Form 06MAY2024
199043	Human Infection with Novel Influenza A Virus Case Report Form	Form	Unchanged	Human Infection with Novel Influenza A Virus Case Report Form (addition of Suspected Avian Source)
199043	Human Infection with Novel Influenza A Virus Case Report Form	Form	Unchanged
199040	Novel Influenza A Virus Case Screening Form	Form and Instruction	Unchanged	Novel Influenza A Virus Case Screening Form 06MAY2024
199040	Novel Influenza A Virus Case Screening Form	Form	Unchanged	Novel Influenza A Virus Case Screening Form
199040	Novel Influenza A Virus Case Screening Form	Form	Unchanged
178374	Viral Gastroenteritis Outbreak Submission Form	Form	Unchanged	Viral Gastroenteritis Outbreak Submission Form
178374	Viral Gastroenteritis Outbreak Submission Form	Form	Unchanged
178365	National Respiratory and Enteric Virus Surveillance System (NREVSS) Laboratory Assessment	Form	Unchanged	NREVSS Virus Isolation (culture) Worksheet
178365	National Respiratory and Enteric Virus Surveillance System (NREVSS) Laboratory Assessment	Form	Unchanged	NREVSS Polymerase Chain Reaction (PCR) Worksheet
178365	National Respiratory and Enteric Virus Surveillance System (NREVSS) Laboratory Assessment	Form	Unchanged	NREVSS Antigen Detection Worksheet
178365	National Respiratory and Enteric Virus Surveillance System (NREVSS) Laboratory Assessment	Form	Unchanged
178364	National Enterovirus Surveillance Report 55.9	Form	Unchanged	Enterovirus Surveillance System Report Form
178364	National Enterovirus Surveillance Report 55.9	Form	Unchanged

ICR Details

OMB Control No: 0920-0004	ICR Reference No: 202512-0920-005
Status: Active	Previous ICR Reference No: 202405-0920-001
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-26-0003
Title: [NCIRD] National Disease Surveillance Program - II. Disease Summaries
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/19/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/08/2025
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2026	04/30/2026	04/30/2026
Responses	134,983	0	134,983
Time Burden (Hours)	27,468	0	27,468
Cost Burden (Dollars)	0	0	0

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Abstract: These data are essential on the local, state, and federal levels for measuring trends in diseases, evaluating the effectiveness of current preventive strategies, and determining the need to modify current preventive measures. The following diseases/conditions are included in this program: Influenza Virus, Caliciviruses, Respiratory and Enteric Viruses, Parechoviruses, Arthropod-Borne Diseases and Enteroviruses. CDC requests approval for a Reinstatement with Change of 0920-0004 National Disease Surveillance Program - II. Disease Summaries. The 12.18.2025 Non-Substantive Change Request is to revise questions to align with EO 14168 Defending Women From Gender Ideology Extremism and Restoring Biological Truth to the Federal Government.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 56955	09/16/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 5358	01/27/2023
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 20

table that charts list of burden

IC Title	Form No.	Form Name
Adenovirus Typing Report Form	0920-26-0003	National Adenovirus Type Reporting System (NATRS) Form
Aggregate counts of persons exposed to Highly Pathogenic Avian Influenza (HPAI	0920-0004, n/a	Aggregate case counts of person exposed to Highly Pathogenic Avian Influenza (HPAI) ,   Aggregate counts of persons exposed to highly pathogenic avian influenza HPAI_06MAY2024
Antiviral Resistant Influenza Infection Case Report Form	none	Antiviral-Resistant Influenza Infection Case Report
Arthropod (Vector)-Borne Diseases (Non-Human Data)	n/a	Arthropod (Vector)-Borne Diseases (Non-Human Data)
Human Infection with Novel Influenza A Virus Case Report Form	0920-0004, NA	Human Infection with Novel Influenza A Virus Case Report Form (addition of Suspected Avian Source) ,   Human Infection with Novel Influenza A Virus Case Report Form 06MAY2024
Human Infections with Novel Influenza A Virus Severe Outcomes	None	Human Infection with Novel Influenza A Virus Severe Outcomes
Influenza Associated Pediatric Mortality Case Report Form	NA	Influenza-Associated Pediatric Mortality Case Report
Influenza Virus Electronic year round - PHLIP_HL7 Messaging Data Elements
Influenza Virus Electronic year round PHIN-MS
Middle East Respiratory Syndrome Coronavirus (MERS) Patient Under Investigation (PUI) Form	None	Middle East Respiratory Syndrome (MERS) Patient Under Investigation (PUI) Short Form
National Enterovirus Surveillance Report 55.9	CDC 55.90	Enterovirus Surveillance System Report Form
National Respiratory and Enteric Virus Surveillance System (NREVSS) Laboratory Assessment	CDC 55.83A, CDC 55.83D, CDC 55.83B	NREVSS Antigen Detection Worksheet ,   NREVSS Polymerase Chain Reaction (PCR) Worksheet ,   NREVSS Virus Isolation (culture) Worksheet
Novel Influenza A Virus Case Screening Form	0920-0004, None	Novel Influenza A Virus Case Screening Form ,   Novel Influenza A Virus Case Screening Form 06MAY2024
Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Form (CRF)	n/a	Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Form (CRF)
Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Short Form	n/a	Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Short Form
Suspect Respiratory Virus Patient Form	NA	Suspect Respiratory Virus Patient Form
U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) Workfolder_CDC 55.20E	CDC 55.20E	U.S. Outpatient Influenza-Like Illness Surveillance Network (ILINet) - Workfolder_CDC 55.20E
US WHO Colloborating Laboratories Influenza Testing Methods Assessment	NA	WHO Collaborating Laboratories Influenza Testing Methods Assessment
Viral Gastroenteritis Outbreak Submission Form	None	Viral Gastroenteritis Outbreak Submission Form
WHO Collaborating Center for Influenza Virus Surveillance	NA	WHO Collaborating Center for Influenza Virus Surveillance

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	134,983	134,983	0	0	0	0
Annual Time Burden (Hours)	27,468	27,468	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $10,955,594

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 12/08/2025

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