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 is listed under ICR 201903-0920-008.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
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	Supplementary Document
Att H - Consent form (Kidney) - English.doc	Supplementary Document
Att G - IACUC Exemption.pdf	Supplementary Document
Att F - Consent Form SPANISH.doc	Supplementary Document
Att F - Consent Form ENGLISH.doc	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All Historical Document Collections

Historical document collections
Reference	Filing	Received	Concluded	Action
201903-0920-008	Reinstatement with change of a previously approved collection	2019-04-24		Approved without change
201701-0920-002	Existing collection in use without an OMB Control Number	2017-01-13		Approved without change

OMB Details

Enrollment Questionnaire for Clinics and Shelter

Federal Enterprise Architecture: Health - Illness Prevention

Information collection instruments
Form	Name	Electronic access	Type
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.