OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Chronic Q Fever in the United States: Enhanced Clinical Surveillance

ICR 202309-0920-006 · OMB 0920-1305 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Form 0920-1305 Chronic Q Fever Enhanced Surveillance (Follow-up0 Form New Repair queued
Form 0920-1305 Chronic Q Fever-Enhanced Surveillance Report Form Form Modified Repair queued
Att 5 Consent Script.docx Supplementary Document Uploaded 2023-09-13 Repair queued
Att 9 Human Subjects Determination.pdf Supplementary Document Uploaded 2023-09-25 Missing upstream
Att 8 Privacy Impact Assessment.pdf Supplementary Document Uploaded 2023-09-13 Repair queued
Att 2 60-Day FRN.pdf Supplementary Document Uploaded 2023-09-13 Repair queued
Att 1 - Authorizing Legislation-Section 301 of the Public Health Service Act (42 USC 241).pdf Supplementary Document Uploaded 2023-09-13 Repair queued
SSB.docx Supporting Statement B Uploaded 2023-09-13 Repair queued
SSA.docx Supporting Statement A Uploaded 2023-09-13 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
262134 Chronic Q Fever Enhanced Surveillance (Follow-up0 Form New
242016 Chronic Q Fever-Enhanced Surveillance Report Form Form Modified
ICR Details
0920-1305 202309-0920-006
Received in OIRA 202004-0920-010
HHS/CDC 0920-1305
Chronic Q Fever in the United States: Enhanced Clinical Surveillance
Revision of a currently approved collection   No
Regular 09/26/2023
  Requested Previously Approved
36 Months From Approved 09/30/2023
100 15
34 5
0 0
The goal of this tool is to establish enhanced medical surveillance for chronic Q fever by gathering additional and more specific clinical data not otherwise collected during the course of routine public health surveillance for chronic Q fever. This information will allow for better characterization of the clinical presentation and risk factors of chronic Q fever in the United States and help educate physicians on identifying and diagnosing these cases.
US Code: 42 USC 241 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  88 FR 41629 06/27/2023
88 FR 66003 09/26/2023
No
  Total Request 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 15 0 35 50 0
Annual Time Burden (Hours) 34 5 0 12 17 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a revision of a currently approved collection. Recently, there has been an increased volume of clinical consultation requests. To reflect this, we are proposing an increase in the number of respondents to 50 each year. Additionally, the clinical course for these patients is often complex, and clinical relapse or prolonged infection has been reported. To capture these important clinical details, we propose increasing the number of total instruments to 2 (two), with a follow-up survey that will take five minutes each at 6, 12, 18, and 24 months from the date of the initial consult.
$5,000
Yes Part B of Supporting Statement
    No
    No
No
No
No
No
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.
09/26/2023