OMB control number

Canine Leptospirosis Surveillance in Puerto Rico

OMB 0920-1170 · HHS/CDC.

OMB 0920-1170

The goals of the data collection are to characterize the epidemiology of canine leptospirosis in Puerto Rico, assess the applicability of canine Leptospira vaccines used in the island, and determine potential rodent, livestock, and wildlife reservoirs for leptospirosis. Findings will be used to develop recommendations for the prevention of leptospirosis in dogs, focus human surveillance efforts, and guide further investigations on leptospirosis in Puerto Rico. In the next two years, several leptospirosis surveillance and research activities in humans, animals and the environment will be developed in Puerto Rico by the CDC and other federal and non-government agencies. The approval of this reinstatement and continuation of information collection for canine leptospirosis will contribute to this One Health understanding of leptospirosis in Puerto Rico.

The latest form for Canine Leptospirosis Surveillance in Puerto Rico expires 2022-05-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form 0920-1170 Case Questionnaire - Dog Owner Form and Instruction
Form 0920-1170 Case Questionnaire - Veterinarian Form and Instruction
Form 0920-1170 Log Sheet Form and Instruction
Form 0920-1170 Enrollment Questionnaire for Clinics and Shelter Form and Instruction
Att I - PIA.pdf Supplementary Document
Att H - Consent form (Kidney) - Spanish.doc (document unavailable) Supplementary Document
Att H - Consent form (Kidney) - English.doc (document unavailable) Supplementary Document
Att G - IACUC Exemption.pdf Supplementary Document
Att F - Consent Form SPANISH.doc Supplementary Document
Att F - Consent Form ENGLISH.doc (document unavailable) Supplementary Document
Att B - 60-Day FRN.pdf Supplementary Document
Att A - Section 301 of the Public Health Service Act (42 USC 241).pdf (document unavailable) Supplementary Document
Supporting Statement B final.docx Supporting Statement B
Supporting Statement A final.docx Supporting Statement A
Case Questionnaire - Dog Owner Form and Instruction
Case Questionnaire - Veterinarian Form and Instruction
Log Sheet Form and Instruction
Enrollment Questionnaire for Clinics and Shelter Form and Instruction

All Historical Document Collections

201903-0920-008 Approved without change	Reinstatement with change of a previously approved collection	2019-04-24
201701-0920-002 Approved without change	Existing collection in use without an OMB Control Number	2017-01-13

OMB Details

Enrollment Questionnaire for Clinics and Shelter

Federal Enterprise Architecture: Health - Illness Prevention

Form 0920-1170	Site Enrollment Questionnaire	Fillable Fileable	Form and instruction
Form 0920-1170	Site Enrollment Quesionnaire Spanish	Fillable Fileable	Form and instruction

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