National Disease Surveillance Program

Forms and Documents

Document Name	Status
Form none assigned National Disease Surveillance Program - 1_Viral Hepatitis Case Record Form	Modified
Form none assigned National Disease Surveillance Program - 1_Typhoid Fever Surveillance Report Form	Modified
Form none assigned National Disease Surveillance Program - 1_Tularemia Form	Modified
Form none assigned National Disease Surveillance Program - 1_Trichinosis Surveillance Case Report Form	Modified
Form none assigned National Disease Surveillance Program - 1_Tick-borne Rickettsial Disease Case Report Form	Modified
Form none assigned National Disease Surveillance Program - 1_Reye Syndrome Case Surveillance Report Form	Modified
Form none assigned National Disease Surveillance Program - 1_Q Fever Form	Modified
Form none assigned National Disease Surveillance Program - 1_Plaque Case Investigation Report Form	Modified
Form none assigned National Disease Surveillance Program - 1_Malaria Case Surveillance Report Form	Modified
Form none assigned National Disease Surveillance Program - 1_Lyme Disease Report Form	Modified
Form none assinged National Disease Surveillance Program - 1_Legionellosis Case Report Form	Modified
Form none assigned National Disease Surveillance Program - 1_Kawasaki Syndrome Form	Modified
Form none assigned National Disease Surveillance Program - 1_Hantavirus Pulmonary Syndrome Form	Modified
Form none assigned National Disease Surveillance Program - 1_Dengue Case Investigation Form	Modified
Form none assigned National Disease Surveillance Program - 1_Cyclosporiasis Form	Modified
Form none assigned National Disease Surveillance Program - 1_CJD Form	Modified
Form none assigned National Disease Surveillance Program - 1_ABC's Invasive MRSA Change Request Form	Modified
DCIF_English_Color_proposed_jun2009.ppt Supplementary Document	2009-06-08
DCIF_English_ColorSept1508_Current.ppt Supplementary Document	2009-06-08
OMB Dengue form- change request.doc Justification for No Material/Nonsubstantive Change	2009-06-08
DCIF_English_Color_proposed_jun2009.ppt Supplementary Document	2009-06-08

IC Document Collections

IC ID	Document Title	Status
46214	National Disease Surveillance Program - 1_Viral Hepatitis Case Record Form	Modified
46213	National Disease Surveillance Program - 1_Typhoid Fever Surveillance Report Form	Modified
46212	National Disease Surveillance Program - 1_Tularemia Form	Modified
46211	National Disease Surveillance Program - 1_Trichinosis Surveillance Case Report Form	Modified
46210	National Disease Surveillance Program - 1_Tick-borne Rickettsial Disease Case Report Form	Modified
46209	National Disease Surveillance Program - 1_Reye Syndrome Case Surveillance Report Form	Modified
46208	National Disease Surveillance Program - 1_Q Fever Form	Modified
46207	National Disease Surveillance Program - 1_Plaque Case Investigation Report Form	Modified
46206	National Disease Surveillance Program - 1_Malaria Case Surveillance Report Form	Modified
46205	National Disease Surveillance Program - 1_Lyme Disease Report Form	Modified
46204	National Disease Surveillance Program - 1_Legionellosis Case Report Form	Modified
46203	National Disease Surveillance Program - 1_Kawasaki Syndrome Form	Modified
46202	National Disease Surveillance Program - 1_Hantavirus Pulmonary Syndrome Form	Modified
46201	National Disease Surveillance Program - 1_Dengue Case Investigation Form	Modified
46200	National Disease Surveillance Program - 1_Cyclosporiasis Form	Modified
46199	National Disease Surveillance Program - 1_CJD Form	Modified
46198	National Disease Surveillance Program - 1_ABC's Invasive MRSA Change Request Form	Modified
37710	National Disease Surveillance Program - 1_ABCs Case Reports Change Request Instruction	Modified

ICR Details

OMB Control No: 0920-0009	ICR Reference No: 200906-0920-018
Status: Historical Active	Previous ICR Reference No: 200807-0920-006
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: National Disease Surveillance Program
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/01/2009
	Date Received in OIRA: 06/19/2009
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2010	03/31/2010	03/31/2010
Responses	56,666	0	56,666
Time Burden (Hours)	13,368	0	13,368
Cost Burden (Dollars)	0	0	0

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Abstract: This a request for minor changes to the Dengue Case Investigation Report form. The changes involve the addition of a record number for tracking and the rewording of some questions for clarification purposes. There is no additional burden. The CDC, working with state Health Departments, propose, coordinate, and evaluate nationwide surveillance systems. State epidemiologists are responsible for the collection, interpretations, and transmission of medical/epidemiological information to CDC. The purpose for reporting communicable diseases is to determine the prevalence of diseases dangerous to public health, provide the basis for planning and evaluating effective programs for prevention and control of infectious diseases, and study present and emerging disease problems. CDC coordination of nationwide reporting maintains uniformity so that comparisons can be made from state to state and year to year.

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Authorizing Statute(s): US Code: 42 USC 306 Name of Law: National Center for Health Statistics
   US Code: 42 USC 301 Name of Law: General Powers and Duties of Public Health Service
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	70 FR 73006	12/08/2005
30-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 66533	11/15/2006
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 18

IC Title	Form No.	Form Name
National Disease Surveillance Program - 1_ABCs Case Reports Change Request	none assigned	ABC
National Disease Surveillance Program - 1_ABC's Invasive MRSA Change Request	none assigned	MRSA
National Disease Surveillance Program - 1_CJD	none assigned	CJD
National Disease Surveillance Program - 1_Cyclosporiasis	none assigned	Cyclosporiasis
National Disease Surveillance Program - 1_Dengue Case Investigation	none assigned, none assigned	Dengue ,   Dengue-Spanish
National Disease Surveillance Program - 1_Trichinosis Surveillance Case Report	none assigned	Trichinosis
National Disease Surveillance Program - 1_Tularemia	none assigned	Tularemia
National Disease Surveillance Program - 1_Typhoid Fever Surveillance Report	none assigned	Typhoid Fever
National Disease Surveillance Program - 1_Viral Hepatitis Case Record	none assigned	Viral Hepatitis
National Disease Surveillance Program - 1_Malaria Case Surveillance Report	none assigned	Malaria
National Disease Surveillance Program - 1_Plaque Case Investigation Report	none assigned	Plague
National Disease Surveillance Program - 1_Q Fever	none assigned	Q Fever
National Disease Surveillance Program - 1_Reye Syndrome Case Surveillance Report	none assigned	Reye Syndrome
National Disease Surveillance Program - 1_Tick-borne Rickettsial Disease Case Report	none assigned	Tick-Borne
National Disease Surveillance Program - 1_Hantavirus Pulmonary Syndrome	none assigned	Hantavirus
National Disease Surveillance Program - 1_Kawasaki Syndrome	none assigned	Kawasaki
National Disease Surveillance Program - 1_Legionellosis Case Report	none assinged	Legionellosis
National Disease Surveillance Program - 1_Lyme Disease Report	none assigned	Lyme Disease

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ICR Summary of Burden

	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	56,666	56,666	0	0	0	0
Annual Time Burden (Hours)	13,368	13,368	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $80,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 06/19/2009

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