OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Enhanced Surveillance of Coccidioidomycosis in Low- and Non-Endemic States

ICR 201505-0920-006 · OMB 0920-1087 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Case Report Form for Coccidioidomycosis Form New Available
Attachment 3 cocci surveillance non-research determination.pdf Supplementary Document Uploaded 2015-05-20 Available
Attach 2 60 day notice.pdf Supplementary Document Uploaded 2015-05-20 Repair queued
Attach 1_Authorizing_Regulations_T42_section_241.doc Supplementary Document Uploaded 2015-05-20 Repair queued
ICR Statement B cocci enhanced surveillance 5.7.15.docx Supporting Statement B Uploaded 2015-05-20 Available
ICR Statement A cocci enhanced surveillance 5.7.15.docx Supporting Statement A Uploaded 2015-05-20 Available
IC Document Collections
IC IDCollectionTypeStatusForm
216654 Case Report Form for Coccidioidomycosis Form New
ICR Details
0920-1087 201505-0920-006
Historical Active
HHS/CDC 15UR
Enhanced Surveillance of Coccidioidomycosis in Low- and Non-Endemic States
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 11/19/2015
Retrieve Notice of Action (NOA) 06/08/2015
  Inventory as of this Action Requested Previously Approved
11/30/2017 24 Months From Approved
145 0 0
48 0 0
0 0 0
Coccidioidomycosis, also called Valley Fever, is a nationally notifiable fungal infection caused by inhalation of soil-dwelling Coccidioides spp. arthroconidia. The goal is to better describe the epidemiological and clinical characteristics of cases in low and non-endemic states. For one year, state health department personnel will conduct phone interviews with reported cases.
US Code: 42 USC 241 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  80 FR 1639 03/27/2015
80 FR 31379 06/02/2015
No
1
IC Title Form No. Form Name
Case Report Form for Coccidioidomycosis none Case Report for Coccidioidomycosis
  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 145 0 0 145 0 0
Annual Time Burden (Hours) 48 0 0 48 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new ICR.
$11,728
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Shari Steinberg 404 639-4942 [email protected]
  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.
06/08/2015