OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

[NCEZID] Characteristics of Cases of Priority Fungal Diseases

ICR 202501-0920-004 · OMB 0920-1385 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Form 0920-1385 Sporotrichosis case report form Form New Missing upstream
Form 0920-1385 Mycetoma case report form Form New Available
Form 0920-1385 Chromoblastomycosis case report form Form New Repair queued
Form 0920-1385 Antifungal-resistant dermatophytosis case report form Form Modified Repair queued
Form 0920-1385 Candida auris Case Report Form Form Modified Repair queued
Form 0920-1385 Blastomycosis Case Report Form Form Modified Repair queued
Form 0920-1385 Histoplasmosis Case Report Form Form Modified Repair queued
Form 0920-1385 Coccidioidomycosis Case Report Form Form Modified Repair queued
Form 0920-1385 Triazole-resistant Aspergillus fumigatus Case Report Form Form Modified Repair queued
Att 1 Section 301 of the Public Health Service Act (42 USC 241).pdf Supplementary Document Uploaded 2025-01-16 Repair queued
Att. 4 Non Research Determination.pdf Supplementary Document Uploaded 2025-01-16 Repair queued
Att. 5- Privacy Impact Assessment.pdf Supplementary Document Uploaded 2024-03-14 Repair queued
Att 4- Human Subjects Determination.pdf Supplementary Document Uploaded 2024-03-14 Repair queued
Att 2-Published 60-day FRN.pdf Supplementary Document Uploaded 2024-03-14 Missing upstream
Att 1 Section 301 of the Public Health Service Act (42 USC 241).pdf Supplementary Document Uploaded 2024-03-14 Repair queued
SSB FungiSurv1_Revision_FINAL.docx Supporting Statement B Uploaded 2025-01-16 Repair queued
SSA FungiSurv1_Revision_FINAL.docx Supporting Statement A Uploaded 2025-01-16 Available
IC Document Collections
IC IDCollectionTypeStatusForm
273720 Sporotrichosis case report form Form New
273719 Mycetoma case report form Form New
273717 Chromoblastomycosis case report form Form New
266002 Antifungal-resistant dermatophytosis case report form Form Modified
266001 Candida auris Case Report Form Form Modified
266000 Blastomycosis Case Report Form Form Modified
265999 Histoplasmosis Case Report Form Form Modified
265998 Coccidioidomycosis Case Report Form Form Modified
254011 Triazole-resistant Aspergillus fumigatus Case Report Form Form Modified
ICR Details
0920-1385 202501-0920-004
Received in OIRA 202402-0920-008
HHS/CDC 0920-1385
[NCEZID] Characteristics of Cases of Priority Fungal Diseases
Revision of a currently approved collection   No
Regular 01/16/2025
  Requested Previously Approved
36 Months From Approved 04/30/2027
2,855 1,375
1,564 1,138
0 0
For patients involving triazole-resistant A. fumigatus isolates detected through passive public health surveillance, we will use a standardized case report form to collect public health surveillance data regarding demographics, underlying medical conditions, treatments, and outcomes. Health departments would be asked to voluntarily fill out the de-identified form. Proposed changes for this Revision include the addition of five new CRFs and changes to a current form.
US Code: 42 USC 241 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  89 FR 85215 10/25/2024
90 FR 2704 01/13/2025
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 2,855 1,375 0 1,480 0 0
Annual Time Burden (Hours) 1,564 1,138 0 426 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a revision to a currently approved collection. Proposed changes include the addition of three new CRFs, corresponding to chromoblastomycosis, mycetoma, and sporotrichosis. The proposed changes increased the annualized burden by 426 hours for a total of 1564 hours.
$5,463
Yes Part B of Supporting Statement
    No
    No
No
No
No
No
Odion Clunis 770 488-0045 [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.
01/16/2025