Information Collection Request

[OS] Emergency Epidemic Investigation Data Collections

ICR 202610-0920-022 · OMB 0920-1011 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 0920-1011 Cladophialophora bantiana Case Report Form_REV 22OCT2026 Form and Instruction Modified Available
Form 0920-1011 Cladophialophora bantiana Case Report Form Form and Instruction Modified Available
0920-1011 Change request_increased rates of C. bantiana.docx Justification for No Material/Nonsubstantive Change Uploaded 2026-10-22 Available
RE_ Submission of LULAC Comment Letter — 0920-1011.pdf Supplementary Document Uploaded 2025-12-29 Available
LULAC Comments - 30-day.pdf Supplementary Document Uploaded 2025-11-20 Available
Attach C_ Steps Conduct Emer Epi Invest.docx Supplementary Document Uploaded 2025-09-22 Available
EEI GenICR_Sup St B_06AUG2025.docx Supporting Statement B Uploaded 2025-09-19 Available
EEI GenICR_Sup St A_06AUG2025.docx Supporting Statement A Uploaded 2025-09-19 Available
60d FRN - published 16JUN2025.pdf Supplementary Document Uploaded 2025-09-19 Available
App 6_Online Survey Case Finding Questionnaire.docx Supplementary Document Uploaded 2022-09-29 Available
App 5_Phone Interview Questionnaire Patient.docx Supplementary Document Uploaded 2022-09-29 Available
App 4_Q Fever Person Interview Questionnaire.docx Supplementary Document Uploaded 2022-09-29 Available
App 3 _Hantav Pulm Synd Questionnaire.docx Supplementary Document Uploaded 2022-09-29 Available
App 2_GBS Case Questionnaire.docx Supplementary Document Uploaded 2022-09-29 Available
App 1_Chart Abstract Form.docx Supplementary Document Uploaded 2022-09-29 Available
Attach H_Biospecimen Storage Consent.docx Supplementary Document Uploaded 2022-09-29 Available
Attach G_Emer Epi Invest_IRB Letter.pdf Supplementary Document Uploaded 2022-09-29 Available
Attach F_Epi Invest SORN.docx Supplementary Document Uploaded 2022-09-29 Available
Attach E_Burden Memo.docx Supplementary Document Uploaded 2022-09-29 Available
Attach D_GenIC Request Form for Emergency Epidemic Investigation.docx Supplementary Document Uploaded 2022-09-29 Available
Attach C_ Steps Conduct Emer Epi Invest.docx Supplementary Document Uploaded 2022-09-29 Available
EEI GenICR_0920-13ZJ_Attach A_Auth Legis Emer Epi Invest_11-06-2013_Subm.pdf Supplementary Document Uploaded 2013-11-20 Available
RE_ Submission of LULAC Comment Letter — 0920-1011.pdf Supplementary Document Uploaded 2025-12-29 Available
LULAC Comments - 30-day.pdf Supplementary Document Uploaded 2025-11-20 Available
Attach C_ Steps Conduct Emer Epi Invest.docx Supplementary Document Uploaded 2025-09-22 Available
EEI GenICR_Sup St B_06AUG2025.docx Supporting Statement B Uploaded 2025-09-19 Available
EEI GenICR_Sup St A_06AUG2025.docx Supporting Statement A Uploaded 2025-09-19 Available
60d FRN - published 16JUN2025.pdf Supplementary Document Uploaded 2025-09-19 Available
App 6_Online Survey Case Finding Questionnaire.docx Supplementary Document Uploaded 2022-09-29 Available
App 5_Phone Interview Questionnaire Patient.docx Supplementary Document Uploaded 2022-09-29 Available
App 4_Q Fever Person Interview Questionnaire.docx Supplementary Document Uploaded 2022-09-29 Available
App 3 _Hantav Pulm Synd Questionnaire.docx Supplementary Document Uploaded 2022-09-29 Available
App 2_GBS Case Questionnaire.docx Supplementary Document Uploaded 2022-09-29 Available
App 1_Chart Abstract Form.docx Supplementary Document Uploaded 2022-09-29 Available
Attach H_Biospecimen Storage Consent.docx Supplementary Document Uploaded 2022-09-29 Available
Attach G_Emer Epi Invest_IRB Letter.pdf Supplementary Document Uploaded 2022-09-29 Available
Attach F_Epi Invest SORN.docx Supplementary Document Uploaded 2022-09-29 Available
Attach E_Burden Memo.docx Supplementary Document Uploaded 2022-09-29 Available
Attach D_GenIC Request Form for Emergency Epidemic Investigation.docx Supplementary Document Uploaded 2022-09-29 Available
Attach C_ Steps Conduct Emer Epi Invest.docx Supplementary Document Uploaded 2022-09-29 Available
EEI GenICR_0920-13ZJ_Attach A_Auth Legis Emer Epi Invest_11-06-2013_Subm.pdf Supplementary Document Uploaded 2013-11-20 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
282617 [NCEZID] Increased rates of Cladophialophora bantiana cases across the United States, 2020-present Form and Instruction ModifiedCladophialophora bantiana Case Report Form_REV 22OCT2026
282617 [NCEZID] Increased rates of Cladophialophora bantiana cases across the United States, 2020-present Form and Instruction ModifiedCladophialophora bantiana Case Report Form

ICR Details

Reginfo record details
table that charts list comparision
  Requested Previously Approved
12/31/2028 12/31/2028
12,000 12,000
6,000 6,000
0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
[NCEZID] Increased rates of Cladophialophora bantiana cases across the United States, 2020-present 0920-1011, 0920-1011 ,  

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 12,000 12,000 0 0 0 0
Annual Time Burden (Hours) 6,000 6,000 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No