Information Collection

Initial Cluster Report

IC 236510 under ICR 202602-0920-009 · OMB 0920-0573.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0573 Initial Cluster Report Form Initial Cluster Report	Form
0920-0573 Initial Cluster Report Form Att_3e Inital Cluster Report Form.pdf	Form
Att_4f Cluster Report Form Instructions Nov 2025.pdf Cluster Report Form Instructions	IC Document

IC Title:

Agency IC Tracking Number:

0920-0573

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.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	0920-0573				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
	Requested	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
Cluster Report Form Instructions		02/23/2026

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

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