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Federal forms, ICRs, and supporting documents

Information Collection Request

Questionnaires for State Epidemiologists Reporting Q Fever (Coxiella burnetii) and for the State Laboratories Testing for Q Fever

ICR 200110-0920-001 · OMB 0920-0529 · Historical Active

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6977 Questionnaires for State Epidemiologists Reporting Q Fever (Coxiella burnetii) and for the State Laboratories Testing for Q Fever Migrated
ICR Details
0920-0529 200110-0920-001
Historical Active
HHS/CDC
Questionnaires for State Epidemiologists Reporting Q Fever (Coxiella burnetii) and for the State Laboratories Testing for Q Fever
New collection (Request for a new OMB Control Number)   No
Emergency 10/22/2001
Approved without change 10/24/2001
Retrieve Notice of Action (NOA) 10/05/2001
Approved consistent with changes described in CDC memo of 10-16- 01 and revised form attached.
  Inventory as of this Action Requested Previously Approved
04/30/2002 04/30/2002
100 0 0
63 0 0
0 0 0
This study will collect retrospective data on Q Fever cases reported to state health departments 1979-1999. These data will be used to establish current baseline incidence rates, geographic distribution, and risk factors for infection. Respondents will be state epidemiologists and laboratory works. In light of the events that occurred on September 11, 2001, we are requesting a emergency extnesion.
None
None
No
  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 100 0 0 100 0 0
Annual Time Burden (Hours) 63 0 0 63 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.
10/05/2001