[NCEZID] School-Based Active Surveillance (SBAS) of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Among Schoolchildren: Phase-2 of the National Roll-Out

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-22HN School District Feedback Form	Form and Instruction	Unchanged	Available
Form 920-22HN Webinar 1 Feedback Form	Form and Instruction	Unchanged	Available
Form 0920-22HN Question Guide for Face-to-Face Evaluation Interviews	Form and Instruction	Unchanged	Available
Form 0920-22HN Attachment C_SBAS_Site Baseline Survey	Form and Instruction	Unchanged	Available
Form 0920-22HN Attachment B_SBAS_Demographic Data Collection Points	Form and Instruction	Unchanged	Available
Form 0920-1396 Electronic Platform Quarterly Chronic Absenteeism Data Reporting Form	Form and Instruction	Modified	Available
1_Supporting Statement A_SBAS_20260417_clean.docx	Supporting Statement A	Uploaded 2026-04-28	Available
2_Supporting Statement B_SBAS_20260415.docx	Supporting Statement B	Uploaded 2026-04-17	Available
4_Appropriation_Language_MECFS_20260415.docx	Supplementary Document	Uploaded 2026-04-16	Available
10_IRB_CDC_091120AI-NE_SBAS.pdf	Supplementary Document	Uploaded 2026-04-16	Available
10_IRB_Advarra_Pro00059494_Exempt Determination Notice_SBAS_Att H.pdf	Supplementary Document	Uploaded 2026-04-16	Available
12_Public_Comments_60-day_FRN_OfSBAS_Responses_20260415.docx	Public Comments	Uploaded 2026-04-16	Available
3_Published_60-day_FRN_CDC-2026-0166-0001_SBAS.pdf	Supplementary Document	Uploaded 2026-04-16	Available
Attachment I_SBAS_Consent Form and Authorization for School District Representatives.docx	Supplementary Document	Uploaded 2022-12-01	Available
Attachment J_SBAS_Consent Form and Authorization for School Nurses.docx	Supplementary Document	Uploaded 2022-12-01	Available
Attachment H_SBAS_NASN IRB Exempt Determination Notice.pdf	Supplementary Document	Uploaded 2022-12-01	Available
Attachment G_SBAS_Privacy Act Checklist Active Surveillance School Age Children.docx	Supplementary Document	Uploaded 2022-12-01	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
257211	School District Feedback Form	Form and Instruction	Unchanged	School District Feedback Form
257210	Webinar 1 Feedback Form	Form and Instruction	Unchanged	Webinar 1 Feedback Form
257209	Question Guide for Face-to-Face Evaluation Interviews	Form and Instruction	Unchanged	Question Guide for Face-to-Face Evaluation Interviews
257208	Site Baseline Survey	Form and Instruction	Unchanged	Attachment C_SBAS_Site Baseline Survey
257207	Demographic Data Collection Points	Form and Instruction	Unchanged	Attachment B_SBAS_Demographic Data Collection Points
257206	Electronic Platform Quarterly Chronic Absenteeism Data Reporting Form	Form and Instruction	Modified	Electronic Platform Quarterly Chronic Absenteeism Data Reporting Form

ICR Details

OMB Control No: 0920-1396	ICR Reference No: 202604-0920-002
Status: Received in OIRA	Previous ICR Reference No: 202212-0920-001
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-26-0182
Title: [NCEZID] School-Based Active Surveillance (SBAS) of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Among Schoolchildren: Phase-2 of the National Roll-Out
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  Yes
Type of Review Request: Regular	Date Submitted to OIRA: 04/28/2026

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	05/31/2026
Responses	238	238
Time Burden (Hours)	951	631
Cost Burden (Dollars)	0	0

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Abstract: ME/CFS is a complex, debilitating, chronic disease that involves several body systems and is hypothesized to contribute to chronic school absenteeism. The condition is characterized by reduced ability to perform pre-illness activities that lasts for more than six months and is accompanied by profound fatigue, which is not improved by rest. Data collection activities associated with the School-Based Active Surveillance (SBAS) of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Among Schoolchildren are designed to test and refine an approach for school-based active surveillance (SBAS) of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) by building on and improving ongoing active surveillance of chronic conditions associated with absenteeism and school withdrawal among US schoolchildren (grades kindergarten through twelve, K-12). This Revision request is submitted to renew the data collection for an additional three years and continue activities associated with Phase-4 which consists of four main components: 1) engage and educate nursing professionals including school nurses, 2) maintain and enhance the electronic data platform for the active surveillance, 3) increase nurse workforce to help ensure students’ health and data collection for the surveillance, and 4) assess burden of ME/CFS using data from Phase-4 for the school-based active surveillance. The Electronic Platform: Quarterly Chronic Absenteeism Data Reporting Form has been revised to account for additional states that have been added over time. There is an increase in burden hours from the previously approved burden estimate.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: U.S. PHSA
  

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:
	91 FR 6219	02/11/2026
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 22821	04/28/2026
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 6

table that charts list of burden

IC Title	Form No.	Form Name
Demographic Data Collection Points	0920-22HN	Attachment B_SBAS_Demographic Data Collection Points
Electronic Platform Quarterly Chronic Absenteeism Data Reporting Form	0920-1396	Electronic Platform Quarterly Chronic Absenteeism Data Reporting Form
Question Guide for Face-to-Face Evaluation Interviews	0920-22HN	Question Guide for Face-to-Face Evaluation Interviews
School District Feedback Form	0920-22HN	School District Feedback Form
Site Baseline Survey	0920-22HN	Attachment C_SBAS_Site Baseline Survey
Webinar 1 Feedback Form	920-22HN	Webinar 1 Feedback Form

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ICR Summary of Burden

table that charts list of burden

	Total Request	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	238	238	0	0	0	0
Annual Time Burden (Hours)	951	631	0	320	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: Revision submitted for 0920-1396 involves modified Electronic Platform Quarterly Chronic Absenteeism Data Reporting Form and increase in burden to 951 burden hours

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Annual Cost to Federal Government: $348,384

Does this IC contain surveys, censuses, or employ statistical methods? No

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:  Yes

Description/Changes for Common Form Usage:  There are no Common Forms associated with this data collection

Approved RCFs using this ICR

table that charts list of RCF

Agency/Sub Agency	RCF ID	RCF Title	RCF Status	IC Title

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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: 04/28/2026

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