Justification for Change - Dengue Case Investigation Report

Change Request for OMB 0920-0009

Dengue Case Investigation Report

The National Center for Zoonotic, Vector-borne, and Enteric Diseases is requesting a review of minor changes and edits to the Dengue Case Investigation Report. These changes are only minor edits and additions and add no additional burden to the patient.

The following changes are being made to the form:

1. Patient data section - Adding “Record Number” to the hospitalized patients data so that appropriate identification and tracking can be confirmed.

2. Patient’s Demographic Information section – Changed “Weeks?” to “Weeks Pregnant (Gestation)” to remove any confusion in the information needed.

3. Additional Patient Data section – Relocated yellow fever vaccination information from the symptoms section.

4. Changed the last section title from “Criteria for DENGUE HEMORRHAGIC FEVER (#1-4), SHOCK (#5), and other symptoms” to “PLEASE describe below the signs and symptoms that the patient has at the time that this form is being completed”.

a. Moved “Tourniquet test” from the 2^nd column to the 1st column.

b. Changed the title “Other symptoms” in the 3^rd column to “Warning signs” for clarification.

c. Added dots connecting the symptoms to the answer boxes.

d. In the 1^st column, added “Fever lasting 2-7 days”

e. Added the word “now” to the current fever status.

f. Added “Anorexia” to the 2^nd column of symptoms

g. Added “Arthritis” to the 3^rd column of symptoms.

h. Removed the numbering in this entire section

We feel that these changes are minor and esthetic edits and add no additional burden to the form. It is our own determination that no PRA process is necessary to allow these changes to be made.

J. Michael Miller, Ph.D., D(ABMM)

Associate Director for Science