OMB control number

SARS-CoV-2 Epidemiologic Data Collections

OMB 0920-1297 · HHS/CDC.

OMB 0920-1297

This data collection is submitted in response to the COVID-19 pandemic by CDC to allow the development of tools that will serve a variety of purposes throughout the remainder of the emergency response. These activities will include filling gaps in knowledge around COVID-19 case characteristics, infection rate, point prevalence in people experiencing homelessness, risks for severe illness or adverse outcomes among pregnant individuals and their newborns, and risk factors for severe illness. The Intended use of the resulting data is to inform guidance on COVID-19.

The latest form for SARS-CoV-2 Epidemiologic Data Collections expires 2020-11-30 and is listed under ICR 202004-0920-016.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
General Public - Risk Factor Interview	Form and Instruction
Epidemiologist - Pregnancy Module	Form and Instruction
Homeless Shelter Staff - Homeless Symptom Follow-Up	Form and Instruction
Homeless Shelter Staff - Homeless Shelter Modified Screener	Form and Instruction
General Public - Household Close-Out Form	Form and Instruction
General Public - Household Animal Queationnaire	Form and Instruction
General Public - Household Member Symptom Diary	Form and Instruction
General Public - Household Questionnaire	Form and Instruction
General Public - Household Contact Questionnaire Instrument	Form and Instruction
General Public - Case Investigation Form	Form and Instruction
Change Request Memo 23SEP2020.docx	Justification for No Material/Nonsubstantive Change
22C. NRD_COVID-19 Pregnancy Module.pdf	Supplementary Document
22B. NRD_Homeless Shelter Screening.pdf	Supplementary Document
22A. Non-research determination.pdf	Supplementary Document
23. Homeless project verbal consent.docx	Supplementary Document
20.Assent_CHILD_27Apr2020_v1.4_CLEAN.docx	Supplementary Document
19. Consent_CASE_27Apr2020_v1.4_CLEAN.docx	Supplementary Document
18. Consent_HH MEMBER_27Apr2020_v1.4_CLEAN.docx	Supplementary Document
17. Consent_PARENT_27Apr2020_v1.4_CLEAN.docx	Supplementary Document
13. Risk Factor_ChartAbstraction0408_Instrument_OMB.docx	Supplementary Document
2. 60-day FRN.pdf	Supplementary Document
1. Section 301 of the Public Health Service Act (42 USC 241).pdf	Supplementary Document
SSB COVID epi forms - NO CF_Clean.docx	Supporting Statement B
SSA COVID epi forms - NO CF_Clean.docx	Supporting Statement A
General Public - Risk Factor Interview	Form and Instruction
Epidemiologist - Pregnancy Module	Form and Instruction
Homeless Shelter Staff - Homeless Symptom Follow-Up	Form and Instruction
Homeless Shelter Staff - Homeless Shelter Modified Screener	Form and Instruction
General Public - Household Close-Out Form	Form and Instruction
General Public - Household Animal Queationnaire	Form and Instruction
General Public - Household Member Symptom Diary	Form and Instruction
General Public - Household Questionnaire	Form and Instruction
General Public - Household Contact Questionnaire Instrument	Form and Instruction
General Public - Case Investigation Form	Form and Instruction

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Concluded	Action
202009-0920-012	No material or nonsubstantive change to a currently approved collection	2020-09-25		Approved without change
202004-0920-016	New collection (Request for a new OMB Control Number)	2020-04-30		Approved with change

OMB Details

General Public - Case Investigation Form

Federal Enterprise Architecture: Disaster Management - Emergency Response

Information collection instruments
Form	Name	Electronic access	Type
Form NA	Case Investigation Form	NA	Form and instruction

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