OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

[NCEZID] School-Based Active Surveillance (SBAS) of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Among Schoolchildren: Phase-2 of the National Roll-Out

ICR 202604-0920-002 · OMB 0920-1396 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Form 0920-22HN School District Feedback Form Form and Instruction Unchanged Available
Form 920-22HN Webinar 1 Feedback Form Form and Instruction Unchanged Available
Form 0920-22HN Question Guide for Face-to-Face Evaluation Interviews Form and Instruction Unchanged Available
Form 0920-22HN Attachment C_SBAS_Site Baseline Survey Form and Instruction Unchanged Available
Form 0920-22HN Attachment B_SBAS_Demographic Data Collection Points Form and Instruction Unchanged Available
Form 0920-1396 Electronic Platform Quarterly Chronic Absenteeism Data Reporting Form Form and Instruction Modified Available
1_Supporting Statement A_SBAS_20260417_clean.docx Supporting Statement A Uploaded 2026-04-28 Available
2_Supporting Statement B_SBAS_20260415.docx Supporting Statement B Uploaded 2026-04-17 Available
4_Appropriation_Language_MECFS_20260415.docx Supplementary Document Uploaded 2026-04-16 Available
10_IRB_CDC_091120AI-NE_SBAS.pdf Supplementary Document Uploaded 2026-04-16 Available
10_IRB_Advarra_Pro00059494_Exempt Determination Notice_SBAS_Att H.pdf Supplementary Document Uploaded 2026-04-16 Available
12_Public_Comments_60-day_FRN_OfSBAS_Responses_20260415.docx Public Comments Uploaded 2026-04-16 Available
3_Published_60-day_FRN_CDC-2026-0166-0001_SBAS.pdf Supplementary Document Uploaded 2026-04-16 Available
Attachment I_SBAS_Consent Form and Authorization for School District Representatives.docx Supplementary Document Uploaded 2022-12-01 Available
Attachment J_SBAS_Consent Form and Authorization for School Nurses.docx Supplementary Document Uploaded 2022-12-01 Available
Attachment H_SBAS_NASN IRB Exempt Determination Notice.pdf Supplementary Document Uploaded 2022-12-01 Available
Attachment G_SBAS_Privacy Act Checklist Active Surveillance School Age Children.docx Supplementary Document Uploaded 2022-12-01 Available
IC Document Collections
IC IDCollectionTypeStatusForm
257211 School District Feedback Form Form and Instruction UnchangedSchool District Feedback Form
257210 Webinar 1 Feedback Form Form and Instruction UnchangedWebinar 1 Feedback Form
257209 Question Guide for Face-to-Face Evaluation Interviews Form and Instruction UnchangedQuestion Guide for Face-to-Face Evaluation Interviews
257208 Site Baseline Survey Form and Instruction UnchangedAttachment C_SBAS_Site Baseline Survey
257207 Demographic Data Collection Points Form and Instruction UnchangedAttachment B_SBAS_Demographic Data Collection Points
257206 Electronic Platform Quarterly Chronic Absenteeism Data Reporting Form Form and Instruction ModifiedElectronic Platform Quarterly Chronic Absenteeism Data Reporting Form
ICR Details
0920-1396 202604-0920-002
Received in OIRA 202212-0920-001
HHS/CDC 0920-26-0182
[NCEZID] School-Based Active Surveillance (SBAS) of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Among Schoolchildren: Phase-2 of the National Roll-Out
Revision of a currently approved collection   Yes
Regular 04/28/2026
  Requested Previously Approved
36 Months From Approved 05/31/2026
238 238
951 631
0 0
ME/CFS is a complex, debilitating, chronic disease that involves several body systems and is hypothesized to contribute to chronic school absenteeism. The condition is characterized by reduced ability to perform pre-illness activities that lasts for more than six months and is accompanied by profound fatigue, which is not improved by rest. Data collection activities associated with the School-Based Active Surveillance (SBAS) of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Among Schoolchildren are designed to test and refine an approach for school-based active surveillance (SBAS) of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) by building on and improving ongoing active surveillance of chronic conditions associated with absenteeism and school withdrawal among US schoolchildren (grades kindergarten through twelve, K-12). This Revision request is submitted to renew the data collection for an additional three years and continue activities associated with Phase-4 which consists of four main components: 1) engage and educate nursing professionals including school nurses, 2) maintain and enhance the electronic data platform for the active surveillance, 3) increase nurse workforce to help ensure students’ health and data collection for the surveillance, and 4) assess burden of ME/CFS using data from Phase-4 for the school-based active surveillance. The Electronic Platform: Quarterly Chronic Absenteeism Data Reporting Form has been revised to account for additional states that have been added over time. There is an increase in burden hours from the previously approved burden estimate.
US Code: 42 USC 241 Name of Law: U.S. PHSA
  
None
Not associated with rulemaking
  91 FR 6219 02/11/2026
91 FR 22821 04/28/2026
Yes
  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 238 238 0 0 0 0
Annual Time Burden (Hours) 951 631 0 320 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
Revision submitted for 0920-1396 involves modified Electronic Platform Quarterly Chronic Absenteeism Data Reporting Form and increase in burden to 951 burden hours
$348,384
No
    No
    No
No
No
No
No
Jeffrey Zirger 404 639-7118 [email protected]
  Yes
  There are no Common Forms associated with this data collection
Agency/Sub Agency RCF ID RCF Title RCF Status IC Title
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.
04/28/2026