National Disease Surveillance Program - II. Disease Summaries

Forms and Documents

Document Name	Status
Att F US WHO Colloborating Laboratories Influenza Testing Methods Assessment Form	Modified
Att. CC Suspect Respiratory Virus Patient Form Form	New
Form CDC 55.20E Att. H U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) Workfolder_CDC 55.20E Form	New
Att X Middle East Respiratory Syndrome Coronavirus (MERS) Patient Under Investigation (PUI) Form Form	Modified
Att W Adenovirus Typing Report Form Form	Modified
Att T Antiviral Resistant Influenza Infection Case Report Form Form	Unchanged
Att M Human Infections with Novel Influenza A Virus Severe Outcomes Form	Unchanged
Att L Human Infection with Novel Influenza A Virus with Suspected Avian Source Form	Removed
Att R_CMRS - City Health Officer or Vital Statistics Registrars Weekly Mortality Report Form	Removed
Form CDC 43.50 Att Q_122 CMRS - City Health Officer or Vital Statistics Registrars Daily Mortality Report Form	Removed
Form CDC 55.20 Att G US Outpatient Influenza-like Illness Surveillance Network (ILINet) Weekly Form	Modified
Att I_ US Outpatient Influenza-like Illiness Surveillance Network (ILINet) Daily Reports Form	Removed
Att J_Influenza Associated Pediatric Mortality Case Report Form Form	Modified
Att E_WHO Collaborating Center for Influenza Virus Surveillance Form	Modified
Att S_Aggregate Hospitalization and Death Reporting Activity Weekly Report Form Form	Removed
Att K Human Infection with Novel Influenza A Virus Case Report Form Form	Modified
Att N Novel Influenza A Virus Infection Contact Tracing Form Form	Removed
Att P Novel Influenza A Virus Case Screening Form Form	Modified
Att O_Novel Influenza A Virus Status Case Status Summary Form	Removed
Att Y_ Viral Gastroenteritis Outbreak Submission Form Form	Modified
Form CDC 52.12 Att Z_ Waterborne Diseases Transmission Form	Modified
Form CDC 52.13 Att D_NORS Foodborne Disease Transmission_ Person to Person Disease Transmission_Animal Contact_Environmental Contamination_Unknown Transmission Mode Form	Modified
Form CDC 55.83A Att U_National Respiratory and Enteric Virus Surveillance System (NREVSS) Laboratory Assessment Form	Modified
Form CDC 55.90 Att V_ National Enterovirus Surveillance Report 55.9 Form	Modified
Attachment DD_Human Subjects Determination 2017_0920-0004 Revision.pdf Supplementary Document	2017-08-30
Attachment C_Disease Summaries_Revision 2017_Final.doc Supplementary Document	2017-08-30
Attachment B_ 60 Day Federal Register Notice_0920_0004.pdf Supplementary Document	2017-08-30
Attachment A_Authorizing Legislation.pdf Supplementary Document	2017-08-30
0920-0004_Supporting Statement B_Revision 2017_Final.docx Supporting Statement B	2017-08-30
SSA 0920-0004 23AUG2017.docx Supporting Statement A	2017-08-30
Change Request 0920-0004_FINAL_clean3.docx Justification for No Material/Nonsubstantive Change	2016-12-23
Non-substantive Change 0920-0004 Water_Foodborne_Flu 122014.docx Justification for No Material/Nonsubstantive Change	2014-12-18

IC Document Collections

IC ID	Document Title	Status
37707	Att F US WHO Colloborating Laboratories Influenza Testing Methods Assessment Form	Modified
228082	Att. CC Suspect Respiratory Virus Patient Form Form	New
228068	Att. H U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) Workfolder_CDC 55.20E Form	New
212473	Att X Middle East Respiratory Syndrome Coronavirus (MERS) Patient Under Investigation (PUI) Form Form	Modified
212472	Att W Adenovirus Typing Report Form Form	Modified
212471	Att T Antiviral Resistant Influenza Infection Case Report Form Form	Unchanged
212470	Att M Human Infections with Novel Influenza A Virus Severe Outcomes Form	Unchanged
212469	Att L Human Infection with Novel Influenza A Virus with Suspected Avian Source Form	Removed
199058	Att R_CMRS - City Health Officer or Vital Statistics Registrars Weekly Mortality Report Form	Removed
199057	Att Q_122 CMRS - City Health Officer or Vital Statistics Registrars Daily Mortality Report Form	Removed
199056	Att G US Outpatient Influenza-like Illness Surveillance Network (ILINet) Weekly Form	Modified
199054	Att I_ US Outpatient Influenza-like Illiness Surveillance Network (ILINet) Daily Reports Form	Removed
199052	Att BB_ Influenza Virus Electronic year round PHIN-MS Other-Variables for Reporting	Unchanged
199051	Att AA_ Influenza Virus Electronic year round - PHLIP_HL7 Messaging Data Elements Other-Variables for Electronic Reporting	Modified
199050	Att J_Influenza Associated Pediatric Mortality Case Report Form Form	Modified
199049	Att E_WHO Collaborating Center for Influenza Virus Surveillance Form	Modified
199045	Att S_Aggregate Hospitalization and Death Reporting Activity Weekly Report Form Form	Removed
199043	Att K Human Infection with Novel Influenza A Virus Case Report Form Form	Modified
199042	Att N Novel Influenza A Virus Infection Contact Tracing Form Form	Removed
199040	Att P Novel Influenza A Virus Case Screening Form Form	Modified
199039	Att O_Novel Influenza A Virus Status Case Status Summary Form	Removed
178374	Att Y_ Viral Gastroenteritis Outbreak Submission Form Form	Modified
178372	Att Z_ Waterborne Diseases Transmission Form	Modified
178369	Att D_NORS Foodborne Disease Transmission_ Person to Person Disease Transmission_Animal Contact_Environmental Contamination_Unknown Transmission Mode Form	Modified
178365	Att U_National Respiratory and Enteric Virus Surveillance System (NREVSS) Laboratory Assessment Form	Modified
178364	Att V_ National Enterovirus Surveillance Report 55.9 Form	Modified

ICR Details

OMB Control No: 0920-0004	ICR Reference No: 201707-0920-010
Status: Historical Active	Previous ICR Reference No: 201612-0920-014
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-0004
Title: National Disease Surveillance Program - II. Disease Summaries
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/12/2017
	Date Received in OIRA: 08/31/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2020	36 Months From Approved	10/31/2017
Responses	133,172	0	175,452
Time Burden (Hours)	24,801	0	32,012
Cost Burden (Dollars)	0	0	0

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Abstract: CDC requests approval for a Revision of 0920-0004 National Disease Surveillance Program - II. Disease Summaries. Revisions include addition of Forms, Discontinuation of Forms, and reformatting some questions. The overall result is a decrease in Burden Hours and Respondents.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act
  

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:
	82 FR 18459	04/19/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 41267	08/30/2017
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 19

IC Title	Form No.	Form Name
Att M Human Infections with Novel Influenza A Virus Severe Outcomes	None	Human Infection with Novel Influenza A Virus Severe Outcomes
Att T Antiviral Resistant Influenza Infection Case Report Form	none	Antiviral-Resistant Influenza Infection Case Report
Att W Adenovirus Typing Report Form	NA	National Adenovirus Type Reporting System (NATRS) Form
Att X Middle East Respiratory Syndrome Coronavirus (MERS) Patient Under Investigation (PUI) Form	None	Middle East Respiratory Syndrome (MERS) Patient Under Investigation (PUI) Short Form
Att J_Influenza Associated Pediatric Mortality Case Report Form	NA	Influenza-Associated Pediatric Mortality Case Report
Att F US WHO Colloborating Laboratories Influenza Testing Methods Assessment	NA	WHO Collaborating Laboratories Influenza Testing Methods Assessment
Att V_ National Enterovirus Surveillance Report 55.9	CDC 55.90	Enterovirus Surveillance System Report Form
Att U_National Respiratory and Enteric Virus Surveillance System (NREVSS) Laboratory Assessment	CDC 55.83A, CDC 55.83D, CDC 55.83B	NREVSS Antigen Detection Worksheet ,   NREVSS Polymerase Chain Reaction (PCR) Worksheet ,   NREVSS Virus Isolation (culture) Worksheet
Att D_NORS Foodborne Disease Transmission_ Person to Person Disease Transmission_Animal Contact_Environmental Contamination_Unknown Transmission Mode	CDC 52.13	NORS - Foodborne, Person-to-Person, Animal Contact, Environmental Contamination, Unknown Transmission Mode
Att Z_ Waterborne Diseases Transmission	CDC 52.12	NORS - Waterborne Disease Transmission
Att Y_ Viral Gastroenteritis Outbreak Submission Form	None	Viral Gastroenteritis Outbreak Submission Form
Att P Novel Influenza A Virus Case Screening Form	None	Novel Influenza A Virus Case Screening Form
Att K Human Infection with Novel Influenza A Virus Case Report Form	NA	Human Infection with Novel Influenza A Virus Case Report Form (addition of Suspected Avian Source)
Att E_WHO Collaborating Center for Influenza Virus Surveillance	NA	WHO Collaborating Center for Influenza Virus Surveillance
Att AA_ Influenza Virus Electronic year round - PHLIP_HL7 Messaging Data Elements
Att BB_ Influenza Virus Electronic year round PHIN-MS
Att G US Outpatient Influenza-like Illness Surveillance Network (ILINet) Weekly	CDC 55.20	US Outpatient Influenza-like Illness Surveillance Network (ILINet) Weekly
Att. H U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) Workfolder_CDC 55.20E	CDC 55.20E	U.S. Outpatient Influenza-Like Illness Surveillance Network (ILINet) - Workfolder_CDC 55.20E
Att I_ US Outpatient Influenza-like Illiness Surveillance Network (ILINet) Daily Reports	None	US Outpatient Influenza like Illness Surveillance Network (ILINet) Daily Reports
Att N Novel Influenza A Virus Infection Contact Tracing Form	None	Novel Influenza A Virus Infection Contact Tracing Form
Att O_Novel Influenza A Virus Status Case Status Summary	None	Novel Influenza A Virus Case Status Summary
Att S_Aggregate Hospitalization and Death Reporting Activity Weekly Report Form	none	Aggregate Hospital
Att R_CMRS - City Health Officer or Vital Statistics Registrars Weekly Mortality Report	CDC 43.5, none	CMRS Weekly ,   122 CMRS-City Health Officers or Vital Statistics Registrars Weekly Mortality Report
Att L Human Infection with Novel Influenza A Virus with Suspected Avian Source	None	Human Infection with Novel Influenza A Virus with Suspected Avian Source
Att Q_122 CMRS - City Health Officer or Vital Statistics Registrars Daily Mortality Report	CDC 43.50	122 CMRS -City Health Officers or Vital Statistics Registrars Daily Mortality Report
Att. CC Suspect Respiratory Virus Patient Form	NA	Suspect Respiratory Virus Patient Form

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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	133,172	175,452	0	-42,280	0	0
Annual Time Burden (Hours)	24,801	32,012	0	-7,211	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Cutting Redundancy

Short Statement: Submission of 0920-0004 is a Revision containing both addition to and subtraction from current Burden Hours for individual collection instruments. Submission of this Revision results in an overall decrease in Burden Hours and Respondents.

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Annual Cost to Federal Government: $9,665,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

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: 08/31/2017

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