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 can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form 0920-22HN School District Feedback Form Form and Instruction
Form 920-22HN Webinar 1 Feedback Form Form and Instruction
Form 0920-22HN Question Guide for Face-to-Face Evaluation Interviews Form and Instruction
Form 0920-22HN Attachment C_SBAS_Site Baseline Survey Form and Instruction
Form 0920-22HN Attachment B_SBAS_Demographic Data Collection Points Form and Instruction
Form 0920-1396 Electronic Platform Quarterly Chronic Absenteeism Data Reporting Form Form and Instruction
1_Supporting Statement A_SBAS_20260417_clean.docx Supporting Statement A
2_Supporting Statement B_SBAS_20260415.docx Supporting Statement B
4_Appropriation_Language_MECFS_20260415.docx Supplementary Document
10_IRB_CDC_091120AI-NE_SBAS.pdf Supplementary Document
10_IRB_Advarra_Pro00059494_Exempt Determination Notice_SBAS_Att H.pdf Supplementary Document
12_Public_Comments_60-day_FRN_OfSBAS_Responses_20260415.docx Public Comments
3_Published_60-day_FRN_CDC-2026-0166-0001_SBAS.pdf Supplementary Document
Attachment I_SBAS_Consent Form and Authorization for School District Representatives.docx Supplementary Document
Attachment J_SBAS_Consent Form and Authorization for School Nurses.docx Supplementary Document
Attachment H_SBAS_NASN IRB Exempt Determination Notice.pdf Supplementary Document
Attachment G_SBAS_Privacy Act Checklist Active Surveillance School Age Children.docx Supplementary 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

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

OMB Details

Electronic Platform Quarterly Chronic Absenteeism Data Reporting Form

Federal Enterprise Architecture: Health - Public Health Monitoring

Form 0920-1396

Electronic Platform Quarterly Chronic Absenteeism Data Reporting Form 08JUN2026

N/A

Form and instruction

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