SARS-CoV-2 Epidemiologic Data Collections

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 can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
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

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

OMB Details

General Public - Case Investigation Form

Federal Enterprise Architecture: Disaster Management - Emergency Response

Form NA

Case Investigation Form

Form and instruction

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