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Federal forms, ICRs, and supporting documents

Information Collection Request

INTEGRATED EVALUATION OF PUBLIC AND PRIVATE SECTOR DISEASE REPORTING AND SERVICE DELIVERY

ICR 199410-0920-004 · OMB 0920-0358 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
111096 INTEGRATED EVALUATION OF PUBLIC AND PRIVATE SECTOR DISEASE REPORTING AND SERVICE DELIVERY Migrated
ICR Details
0920-0358 199410-0920-004
Historical Active
HHS/CDC
INTEGRATED EVALUATION OF PUBLIC AND PRIVATE SECTOR DISEASE REPORTING AND SERVICE DELIVERY
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 01/16/1995
Retrieve Notice of Action (NOA) 10/18/1994
As indicated on PHS's 01/10/95 response, the information on race and ethnicity for patients and providers is only approximate and should be caveated in any reported results of this four state evaluation.
  Inventory as of this Action Requested Previously Approved
06/30/1996 06/30/1996
1,000 0 0
882 0 0
0 0 0
S, SYPHILIS, GONORRHEA' A SURVEY METHODOLOGY HAS BEEN DEVELPED TO COLLECT INFORMATION ON STD CASES SEEN BY PHYSICIANS AND NURSING PROFESSIONALS WORKING BOTH INDEPENDENTLY OR IN PUBLIC AND PRIVATE INSTITUTIONS. THIS METHODOLOGY WILL BE USED TO ESTIMATE THE ACTUAL NUMBER OF SYPHILIS AND GONORRHEA CASES OCCURRING OVER A 1-YEAR PERIOD. THESE NUMBERS WILL BE COMPARED TO THE ACTUAL NUMBER OF CASES REPORTED TO THE CDC SURVEILLANCE SYSTEM BY STATE DEPARTMENT OF HEALTH.
None
None
No
1
IC Title Form No. Form Name
INTEGRATED EVALUATION OF PUBLIC AND PRIVATE SECTOR DISEASE REPORTING AND SERVICE DELIVERY
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 1,000 0 0 1,000 0 0
Annual Time Burden (Hours) 882 0 0 882 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No
$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
10/18/1994