Information Collection

[NCEZID] Increased rates of Cladophialophora bantiana cases across the United States, 2020-present

IC 282617 under ICR 202610-0920-022 · OMB 0920-1011.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1011 Cladophialophora bantiana Case Report Form [NCEZID] Increased rates of Cladophialophora bantiana cases across the United States, 2020-present	Form and Instruction
Form 0920-1011 Cladophialophora bantiana Case Report Form_REV 22OCT2026 [NCEZID] Increased rates of Cladophialophora bantiana cases across the United States, 2020-present	Form and Instruction
0920-1011 Cladophialophora bantiana Case Report Form CRF_C. bantiana_National Investigation_FINAL_Privacy.docx	Form and Instruction
0920-1011 Cladophialophora bantiana Case Report Form_REV 22OCT2026 CRF_C. bantiana_National Investigation_FINAL_Privacy_CLEAN.docx	Form and Instruction
Burden Memo_National increase of C. bantiana_FINAL.docx Burden Request Memo	IC Document
C bantiana_Letter of Support_WA_FINAL.docx Letter of Invitation WA C.bantiana	IC Document
GenIC Request Form EEI_C. bantiana increase_FINAL_Stats.docx 0920-1011 GenIC Request Template C.bantiana	IC Document
Terms of Clearance-30September2026.pdf Terms of Clearance-30September2026	IC Document
0920-1011 Change request_increased rates of C. bantiana.docx Change Request Memo - C.bantiana_22OCT2026	IC Document

IC Title:

Agency IC Tracking Number:

IC Status: Modified

Obligation to Respond: Voluntary

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	0920-1011			N/A	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1011			N/A	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title: 09-20-0136 - Epidemiologic Studies and Surveillance of Disease Problems

FR Citation: 83 FR 6591

Number of Respondents: 150

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	350	350
Annual IC Time Burden (Hours)	175	175
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Burden Request Memo		09/25/2026
Letter of Invitation WA C.bantiana		09/25/2026
0920-1011 GenIC Request Template C.bantiana		09/30/2026
Terms of Clearance-30September2026		09/30/2026
Change Request Memo - C.bantiana_22OCT2026		10/22/2026

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

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