OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

National Disease Surveillance Program - II. Disease Summaries

ICR 201407-0920-012 · OMB 0920-0004 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form CDC 55.31A Att F US WHO Colloborating Laboratories Influenza Testing Methods Assessment Form Modified Available
Att X Middle East Respiratory Syndrome Coronavirus (MERS) Patient Under Investigation (PUI) Form Form New Available
Att W Adenovirus Typing Report Form Form New Repair queued
Att T Antiviral Resistant Influenza Infection Case Report Form Form New Available
Att M Human Infections with Novel Influenza A Virus Severe Outcomes Form New Repair queued
Att L Human Infection with Novel Influenza A Virus with Suspected Avian Source Form New Available
Form CDC 43.5 Att R_CMRS - City Health Officer or Vital Statistics Registrars Weekly Mortality Report Form Modified Available
Form CDC 43.50 Att Q_122 CMRS - City Health Officer or Vital Statistics Registrars Daily Mortality Report Form Modified Repair queued
Form CDC 55.20 Att G US Outpatient Influenza-like Illness Surveillance Network (ILINet) Weekly Form Modified Repair queued
Daily Influenza-like Illness Oct - May Form Removed Repair queued
Att I_ US Outpatient Influenza-like Illiness Surveillance Network (ILINet) Daily Reports Form Modified Repair queued
Form 55.20 Weekly Influenza-like Illness Oct - May 55.20 Form Removed Available
Att J_Influenza Associated Pediatric Mortality Case Report Form Form Modified Repair queued
Form CDC 55.31 Att E_WHO Collaborating Center for Influenza Virus Surveillance Internet Year Round Form Modified Repair queued
Influenza virus Internet Oct - May 55.31 Form Removed Available
Influenza virus fax year-round 55.31 Form Removed Repair queued
Form Influenza Fax Influenza Virus Fax Oct-May 55.31 Form Removed Repair queued
Att S_Aggregate Hospitalization and Death Reporting Activity Weekly Report Form Form Modified Repair queued
Att K Human Infection with Novel Influenza A Virus Case Report Form Form Modified Available
Att N Novel Influenza A Virus Infection Contact Tracing Form Form Modified Repair queued
Novel and Pandemic Influenza A Virus Infection Contact Trace Back Form Form Removed Available
Att P Novel Influenza A Virus Case Screening Form Form Modified Repair queued
Att O_Novel Influenza A Virus Status Case Status Summary Form Modified Available
Form No Number HABISS Monthly Reporting Form Form Removed Repair queued
Form No number HABISS Form Removed Available
Att Y_ Form for Submitting Specimens from Suspected Norovirus Outbreak Form Modified Available
Form CDC 52.12 Att Z_ Waterborne Diseases Transmission Form and Instruction Modified Available
Form CDC 52.13 Att D_Foodborne Disease Transmission Person-to-Person_Animal Contact Form and Instruction Modified Available
Form CDC 55.83 Att U_National Respiratory and Enteric Virus Surveillance System (NREVSS) Laboratory Assessment Form Modified Repair queued
Form CDC 55.90 Att V_ National Enterovirus Surveillance Report 55.9 Form Modified Available
Att G_US Outpatient ILI Surv Network (ILINet) Weekly CDC 55.20.pdf Supplementary Document Uploaded 2014-08-18 Repair queued
SupSta A_0920-0004_REVISION.doc Supporting Statement A Uploaded 2014-07-25 Available
Att C_60d FRN (0920-0004).pdf Supplementary Document Uploaded 2014-07-25 Available
Att B_Disease Summaries.doc Supplementary Document Uploaded 2014-07-25 Available
Att A_Authorizing Legislation.pdf Supplementary Document Uploaded 2014-07-25 Available
SupSta B_0920-0004_REVISION.docx Supporting Statement B Uploaded 2014-07-25 Available
IC Document Collections
IC IDCollectionTypeStatusForm
37707 Att F US WHO Colloborating Laboratories Influenza Testing Methods Assessment Form Modified
212473 Att X Middle East Respiratory Syndrome Coronavirus (MERS) Patient Under Investigation (PUI) Form Form New
212472 Att W Adenovirus Typing Report Form Form New
212471 Att T Antiviral Resistant Influenza Infection Case Report Form Form New
212470 Att M Human Infections with Novel Influenza A Virus Severe Outcomes Form New
212469 Att L Human Infection with Novel Influenza A Virus with Suspected Avian Source Form New
199058 Att R_CMRS - City Health Officer or Vital Statistics Registrars Weekly Mortality Report Form Modified
199057 Att Q_122 CMRS - City Health Officer or Vital Statistics Registrars Daily Mortality Report Form Modified
199056 Att G US Outpatient Influenza-like Illness Surveillance Network (ILINet) Weekly Form Modified
199055 Daily Influenza-like Illness Oct - May Form Removed
199054 Att I_ US Outpatient Influenza-like Illiness Surveillance Network (ILINet) Daily Reports Form Modified
199053 Weekly Influenza-like Illness Oct - May 55.20 Form Removed
199052 Att BB_ Influenza Virus Electronic year round PHIN-MS Other-Variables for Reporting Modified
199051 Att AA_ Influenza Virus Electronic year round - PHLIP_HL7 Messaging Data Elements Other-Variables for Electronic Reporting Modified
199050 Att J_Influenza Associated Pediatric Mortality Case Report Form Form Modified
199049 Att E_WHO Collaborating Center for Influenza Virus Surveillance Internet Year Round Form Modified
199048 Influenza virus Internet Oct - May 55.31 Form Removed
199047 Influenza virus fax year-round 55.31 Form Removed
199046 Influenza Virus Fax Oct-May 55.31 Form Removed
199045 Att S_Aggregate Hospitalization and Death Reporting Activity Weekly Report Form Form Modified
199043 Att K Human Infection with Novel Influenza A Virus Case Report Form Form Modified
199042 Att N Novel Influenza A Virus Infection Contact Tracing Form Form Modified
199041 Novel and Pandemic Influenza A Virus Infection Contact Trace Back Form Form Removed
199040 Att P Novel Influenza A Virus Case Screening Form Form Modified
199039 Att O_Novel Influenza A Virus Status Case Status Summary Form Modified
186749 HABISS Monthly Reporting Form Form Removed
186748 HABISS Form Removed
178374 Att Y_ Form for Submitting Specimens from Suspected Norovirus Outbreak Form Modified
178372 Att Z_ Waterborne Diseases Transmission Form and Instruction Modified
178369 Att D_Foodborne Disease Transmission Person-to-Person_Animal Contact Form and Instruction Modified
178365 Att U_National Respiratory and Enteric Virus Surveillance System (NREVSS) Laboratory Assessment Form Modified
178364 Att V_ National Enterovirus Surveillance Report 55.9 Form Modified
ICR Details
0920-0004 201407-0920-012
Historical Active 201402-0920-007
HHS/CDC 21418
National Disease Surveillance Program - II. Disease Summaries
Revision of a currently approved collection   No
Regular
Approved without change 10/29/2014
Retrieve Notice of Action (NOA) 08/25/2014
  Inventory as of this Action Requested Previously Approved
10/31/2017 36 Months From Approved 10/31/2014
175,180 0 199,167
31,921 0 48,493
0 0 0
The Centers for Disease Control and Prevention (CDC) requests a three year approval for the Revision of National Disease Surveillance Program - II. Disease Summaries, OMB Control Number 0920-0004. Expiration Date August 31, 2014. Proposed revisions include shifting information collection management responsibilities to the National Center for Immunization and Respiratory Diseases (NCIRD) and consolidating various forms to reflect more current technology trends. CDC also requests the use of 2 new Influenza forms to enhance surveillance and assist in understanding the complexities of these newer viruses: Human Infection with Novel Influenza A Virus Severe Outcomes; Human Infection with Novel Influenza A Virus with Suspected Avian Source. Due to the uncertainty regarding MERS-CoV and the potential threat to human health, CDC has developed a new form, Middle East Respiratory Syndrome Coronavirus (MERS-CoV) [Patient Under Investigation] form. The Adenovirus Typing Report Form allows for a passive surveillance mechanism that collects adenovirus typing data to enhance adenovirus circulation data already collected by the National Respiratory and Enteric Virus Surveillance System (NREVSS). The Harmful Algal Bloom-related Illness forms are being discontinued. The methodology for reporting varies depending on the occurrence, modes of transmission, infectious agents, and epidemiologic measures. There is no cost to respondents other than their time.
US Code: 42 USC 241 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  79 FR 37 02/25/2014
79 FR 46828 08/11/2014
No
24
IC Title Form No. Form Name
Daily Influenza-like Illness Oct - May none Influenza-like Illness Daily and year round
Att F US WHO Colloborating Laboratories Influenza Testing Methods Assessment CDC 55.31A US WHO Collaborating Laboratories Flu Testing Methods Assessment
Att V_ National Enterovirus Surveillance Report 55.9 CDC 55.90 Enterovirus Surveillance System Report Form
Att U_National Respiratory and Enteric Virus Surveillance System (NREVSS) Laboratory Assessment CDC 55.83A, CDC 55.83D, CDC 55.83, CDC 55.83B National Respiratory and Enteric Virus Surveillance System (NREVSS) Laboratory Assessment ,   NREVSS Antigen Detection Worksheet ,   NREVSS Polymerase Chain Reaction (PCR) Worksheet ,   NREVSS Virus Isolation (culture) Worksheet
Att D_Foodborne Disease Transmission Person-to-Person_Animal Contact CDC 52.13 National Outbreak Reporting System
Att Z_ Waterborne Diseases Transmission CDC 52.12 National Outbreak Reporting System: Waterborne Disease Transmission
Att Y_ Form for Submitting Specimens from Suspected Norovirus Outbreak None Form for Submitting Specimens from Suspected Norovirus Outbreaks
HABISS Monthly Reporting Form No Number HABISS Report
Att O_Novel Influenza A Virus Status Case Status Summary None Novel Influenza A Virus Case Status Summary
Att P Novel Influenza A Virus Case Screening Form None Novel Influenza A Virus Case Screening Form
Influenza virus fax year-round 55.31 none WHO Fax Form
HABISS No number HABISS
Att K Human Infection with Novel Influenza A Virus Case Report Form none, None Human Infection with Novel Influenza A Virus Case Report Form ,   Human Infection with Novel Influenza A Virus Case Report Form
Att S_Aggregate Hospitalization and Death Reporting Activity Weekly Report Form none Aggregate Hospital
Influenza virus Internet Oct - May 55.31 none WHO Electronic
Att E_WHO Collaborating Center for Influenza Virus Surveillance Internet Year Round CDC 55.31 WHO Collaborating Center for Influenza Virus Surveillance (Internet: Year Round)
Att AA_ Influenza Virus Electronic year round - PHLIP_HL7 Messaging Data Elements
Att BB_ Influenza Virus Electronic year round PHIN-MS
Att I_ US Outpatient Influenza-like Illiness Surveillance Network (ILINet) Daily Reports None US Outpatient Influenza like Illness Surveillance Network (ILINet) Daily Reports
Att G US Outpatient Influenza-like Illness Surveillance Network (ILINet) Weekly CDC 55.20 US Outpatient Influenza-like Illness Surveillance Network (ILINet) Weekly
Att Q_122 CMRS - City Health Officer or Vital Statistics Registrars Daily Mortality Report CDC 43.50 122 CMRS -City Health Officers or Vital Statistics Registrars Daily Mortality Report
Att R_CMRS - City Health Officer or Vital Statistics Registrars Weekly Mortality Report CDC 43.5, none 122 CMRS-City Health Officers or Vital Statistics Registrars Weekly Mortality Report ,   CMRS Weekly
Att L Human Infection with Novel Influenza A Virus with Suspected Avian Source None Human Infection with Novel Influenza A Virus with Suspected Avian Source
Att M Human Infections with Novel Influenza A Virus Severe Outcomes None Human Infection with Novel Influenza A Virus Severe Outcomes
Att T Antiviral Resistant Influenza Infection Case Report Form None Antiviral Resistant Influenza Infection Case Report Form
Att W Adenovirus Typing Report Form None Adenovirus Typing Report Form
Att X Middle East Respiratory Syndrome Coronavirus (MERS) Patient Under Investigation (PUI) Form None Middle East Respiratory Syndrome Coronavirus (MERS) Patient Under Investigation (PUI) Form
Weekly Influenza-like Illness Oct - May 55.20 55.20 Weekly Influenza-like Illness
Novel and Pandemic Influenza A Virus Infection Contact Trace Back Form none Influenza A Trace Back
Att N Novel Influenza A Virus Infection Contact Tracing Form None Novel Influenza A Virus Infection Contact Tracing Form
Influenza Virus Fax Oct-May 55.31 Influenza Fax WHO Fax Form
Att J_Influenza Associated Pediatric Mortality Case Report Form None Influenza Associated Pediatric Mortality Case Report Form
  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 175,180 199,167 0 -4,514 -19,473 0
Annual Time Burden (Hours) 31,921 48,493 0 -10,841 -5,731 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
Yes
Changing Forms
This is a request for a revision. Proposed revisions include shifting information collection management responsibilities to the National Center for Immunization and Respiratory Diseases (NCIRD) and consolidating various forms to reflect more current technology trends.
$51,000
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Thelma Sims 4046394771
  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.
08/25/2014