[NCEZID] Contact Investigation Outcome Reporting Forms

OMB 0920-0900

The purpose of this information collection is to obtain sufficient information on the results of contact investigations carried out by state and local public health professionals or maritime medical crews to assess the impact of a confirmed communicable disease of public health concern in a traveler. Information is used to assess the impact in terms of spread and health outcomes and to determine if further public health intervention is appropriate. Communicable diseases of interest include clinically active tuberculosis (TB), varicella, influenza-like illness, measles, and rubella. The purpose of this non-substantive Change Request (submitted August 2018) is to clarify the wording of selected questions on the ILI Outbreak Enhanced Data Collection Form.

The latest form for [NCEZID] Contact Investigation Outcome Reporting Forms expires 2021-05-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form 0920-0900 Att G_Influenza Outbreak Enhanced Data Collection Form – Maritime Form and Instruction
Form 0920-0900 Att F_Varicella Outbreak Enhanced Data Collection Form - Maritime Form
Form 0920-0900 Att K_Rubella Aircraft Contact Investigation Outcome Reporting Form
Form 0920-0900 Att J_Measles Aircraft Contact Investigation Outcome Reporting Form Form
Form 0920-0900 Att E_TB Maritime Contact Investigation Worksheet Form
Form 0920-0900 Att I_General Land Contact Investigation Outcome Reporting Form Form
Form 0920-0900 Att H_General Aircraft Contact Investigation Outcome Reporting Form Form
Form 0920-0900 Att L_General Land Contact Investigation Outcome Reporting Form Form
0920-0900 SupSta B_FINAL.docx Supporting Statement B
0920-0900 SupSta A_FINAL_081924.docx Supporting Statement A
Att. M-QARS_PIA_Signed_2022-07-29.pdf Supplementary Document
Att. D Non-researach Determination.pdf Supplementary Document
Att. M-QARS_PIA.pdf Supplementary Document
Att. B-60 Day Federal Register Notice_0920-0900_6.4.2024.pdf Supplementary Document
Att. A3-42 CFR part 71 Authorizing Legislation.pdf Supplementary Document
Att. A2-42 CFR part 70 Authorizing Legislation.pdf Supplementary Document
Att. A1-Section 361 of the Public Health Service Act (42 USC 264).pdf Supplementary Document
Att G_Influenza Outbreak Enhanced Data Collection Form – Maritime Form and Instruction
Att F_Varicella Outbreak Enhanced Data Collection Form - Maritime Form
Att K_Rubella Aircraft Contact Investigation Outcome Reporting Form
Att J_Measles Aircraft Contact Investigation Outcome Reporting Form Form
Att E_TB Maritime Contact Investigation Worksheet Form
Att I_General Land Contact Investigation Outcome Reporting Form Form
Att H_General Aircraft Contact Investigation Outcome Reporting Form Form
Att L_General Land Contact Investigation Outcome Reporting Form Form

All Historical Document Collections

202408-0920-006	Revision of a currently approved collection	2024-08-20
202111-0920-004 Approved without change	No material or nonsubstantive change to a currently approved collection	2021-11-02
202105-0920-009 Approved without change	Revision of a currently approved collection	2021-05-28
201808-0920-021 Approved without change	No material or nonsubstantive change to a currently approved collection	2018-08-29
201802-0920-005 Approved without change	Revision of a currently approved collection	2018-04-20
201712-0920-005 Approved without change	No material or nonsubstantive change to a currently approved collection	2017-12-14
201609-0920-017 Approved without change	No material or nonsubstantive change to a currently approved collection	2016-09-29
201510-0920-003 Approved without change	No material or nonsubstantive change to a currently approved collection	2015-10-21
201502-0920-008 Approved with change	Revision of a currently approved collection	2015-03-03
201407-0920-002 Approved with change	Revision of a currently approved collection	2014-07-17
201106-0920-017 Approved without change	New collection (Request for a new OMB Control Number)	2011-06-27
201106-0920-007 Improperly submitted	New collection (Request for a new OMB Control Number)	2011-06-10
201106-0920-002 Improperly submitted	New collection (Request for a new OMB Control Number)	2011-06-01

OMB Details

State/Local General Contact Reporting (Land)

Federal Enterprise Architecture: Health - Public Health Monitoring

Form n/a

General Contact Investigation Outcome Reporting Form (Land)

Fillable Fileable

Form

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.