OMB control number
Chronic Q Fever in the United States: Enhanced Clinical Surveillance
OMB 0920-1305 ยท HHS/CDC.
OMB 0920-1305
The goal of this tool is to establish enhanced medical surveillance for chronic Q fever by gathering additional and more specific clinical data not otherwise collected during the course of routine public health surveillance for chronic Q fever. This information will allow for better characterization of the clinical presentation and risk factors of chronic Q fever in the United States and help educate physicians on identifying and diagnosing these cases.
The latest form for Chronic Q Fever in the United States: Enhanced Clinical Surveillance expires 2026-11-30 and is listed under ICR 202309-0920-006.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form 0920-1305 Chronic Q Fever Enhanced Surveillance (Follow-up0 | Form |
| Form 0920-1305 Chronic Q Fever-Enhanced Surveillance Report Form | Form |
 Att 5 Consent Script.docx | Supplementary Document |
| Att 9 Human Subjects Determination.pdf | Supplementary Document |
| Att 8 Privacy Impact Assessment.pdf | Supplementary Document |
| Att 2 60-Day FRN.pdf | Supplementary Document |
| Att 1 - Authorizing Legislation-Section 301 of the Public Health Service Act (42 USC 241).pdf | Supplementary Document |
| SSB.docx | Supporting Statement B |
| SSA.docx | Supporting Statement A |
 Chronic Q Fever Enhanced Surveillance (Follow-up0 |
Form |
| Chronic Q Fever-Enhanced Surveillance Report Form |
Form |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202309-0920-006 | Revision of a currently approved collection | 2023-09-26 | Approved without change | |
| 202004-0920-010 | New collection (Request for a new OMB Control Number) | 2020-05-29 | Approved without change |
OMB Details
Chronic Q Fever-Enhanced Surveillance Report Form
Federal Enterprise Architecture: Health - Public Health Monitoring
| Form | Name | Electronic access | Type |
|---|---|---|---|
| Form 0920-1305 | Q Fever Case Report | Fillable Fileable | Form |
Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.