OMB control number

[NCEZID] School-Based Active Surveillance (SBAS) of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Among Schoolchildren: Phase-2 of the National Roll-Out

OMB 0920-1396 · HHS/CDC.

OMB 0920-1396

ME/CFS is a complex, debilitating, chronic disease that involves several body systems and is hypothesized to contribute to chronic school absenteeism. The condition is characterized by reduced ability to perform pre-illness activities that lasts for more than six months and is accompanied by profound fatigue, which is not improved by rest. Data collection activities associated with the School-Based Active Surveillance (SBAS) of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Among Schoolchildren are designed to test and refine an approach for school-based active surveillance (SBAS) of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) by building on and improving ongoing active surveillance of chronic conditions associated with absenteeism and school withdrawal among US schoolchildren (grades kindergarten through twelve, K-12). This Revision request is submitted to renew the data collection for an additional three years and continue activities associated with Phase-4 which consists of four main components: 1) engage and educate nursing professionals including school nurses, 2) maintain and enhance the electronic data platform for the active surveillance, 3) increase nurse workforce to help ensure students’ health and data collection for the surveillance, and 4) assess burden of ME/CFS using data from Phase-4 for the school-based active surveillance. The Electronic Platform: Quarterly Chronic Absenteeism Data Reporting Form has been revised to account for additional states that have been added over time. There is an increase in burden hours from the previously approved burden estimate.

The latest form for [NCEZID] School-Based Active Surveillance (SBAS) of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Among Schoolchildren: Phase-2 of the National Roll-Out expires 2029-06-30 and is listed under ICR 202604-0920-002.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form 0920-22HN School District Feedback FormForm and Instruction
Form 920-22HN Webinar 1 Feedback FormForm and Instruction
Form 0920-22HN Question Guide for Face-to-Face Evaluation InterviewsForm and Instruction
Form 0920-22HN Attachment C_SBAS_Site Baseline SurveyForm and Instruction
Form 0920-22HN Attachment B_SBAS_Demographic Data Collection PointsForm and Instruction
Form 0920-1396 Electronic Platform Quarterly Chronic Absenteeism Data Reporting FormForm and Instruction
1_Supporting Statement A_SBAS_20260417_clean.docxSupporting Statement A
2_Supporting Statement B_SBAS_20260415.docxSupporting Statement B
4_Appropriation_Language_MECFS_20260415.docxSupplementary Document
10_IRB_CDC_091120AI-NE_SBAS.pdfSupplementary Document
10_IRB_Advarra_Pro00059494_Exempt Determination Notice_SBAS_Att H.pdfSupplementary Document
12_Public_Comments_60-day_FRN_OfSBAS_Responses_20260415.docxPublic Comments
3_Published_60-day_FRN_CDC-2026-0166-0001_SBAS.pdfSupplementary Document
Attachment I_SBAS_Consent Form and Authorization for School District Representatives.docxSupplementary Document
Attachment J_SBAS_Consent Form and Authorization for School Nurses.docxSupplementary Document
Attachment H_SBAS_NASN IRB Exempt Determination Notice.pdfSupplementary Document
Attachment G_SBAS_Privacy Act Checklist Active Surveillance School Age Children.docxSupplementary Document
School District Feedback Form Form and Instruction
Webinar 1 Feedback Form Form and Instruction
Question Guide for Face-to-Face Evaluation Interviews Form and Instruction
Site Baseline Survey Form and Instruction
Demographic Data Collection Points Form and Instruction
Electronic Platform Quarterly Chronic Absenteeism Data Reporting Form Form and Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202604-0920-002 Revision of a currently approved collection 2026-04-28
202212-0920-001 New collection (Request for a new OMB Control Number) 2022-12-13 Approved without change

OMB Details

Electronic Platform Quarterly Chronic Absenteeism Data Reporting Form

Federal Enterprise Architecture: Health - Public Health Monitoring

Information collection instruments
FormNameElectronic accessType
Form 0920-1396Electronic Platform Quarterly Chronic Absenteeism Data Reporting Form 08JUN2026N/AForm and instruction

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