US Tuberculosis Follow-up Worksheet for Newly Admitted Persons with Overseas Tuberculosis Classifications

Forms and Documents

Document Name	Status
EDN TB Follow-up Worksheet Form	New
Attachment 5–CDC Non-Research Determination.pdf Supplementary Document	2018-04-26
Attachment 4-EDN_PIA_2014-12-23.pdf Supplementary Document	2018-04-26
Attachment 2 60 Day Federal Register Notice.pdf Supplementary Document	2018-04-26
Attachment 1C- 42 CFR Part 34.pdf Supplementary Document	2018-04-26
Attachment 1B-Public Health Service Act 42 U.S.C. 252.pdf Supplementary Document	2018-04-26
Attachment 1A-Immigration and Nationality Act 8 U.S.C. § 1182.pdf Supplementary Document	2018-04-26
Supporting Statement B-TB Follow up Worksheet_CLEAN.DOCX Supporting Statement B	2018-04-26
Supporting Statement A-TB Follow up Worksheet (002)_CLEAN.DOCX Supporting Statement A	2018-04-26

IC Document Collections

IC ID	Document Title	Status
231229	EDN TB Follow-up Worksheet Form	New

ICR Details

OMB Control No: 0920-1238	ICR Reference No: 201804-0920-016
Status: Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-18KG
Title: US Tuberculosis Follow-up Worksheet for Newly Admitted Persons with Overseas Tuberculosis Classifications
Type of Information Collection: Existing collection in use without an OMB Control Number	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/15/2018
	Date Received in OIRA: 05/14/2018
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2021	36 Months From Approved
Responses	26,400	0	0
Time Burden (Hours)	13,200	0	0
Cost Burden (Dollars)	493,416	0	0

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Abstract: The purpose of this data collection is to follow-up with and assess newly arrived persons in the US who received overseas TB classifications in order to assist in the national effort to prevent new transmission of TB.

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Authorizing Statute(s): US Code: 8 USC 1182 Name of Law: Immigration and Nationality Act
   US Code: 42 USC 252 Name of Law: PHSA
  

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:
	83 FR 4484	01/31/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 22072	05/11/2018
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
EDN TB Follow-up Worksheet	none	EDN TB Follow-up Worksheet

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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	26,400	0	0	0	0	26,400
Annual Time Burden (Hours)	13,200	0	0	0	0	13,200
Annual Cost Burden (Dollars)	493,416	0	0	0	0	493,416

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: $139,500

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

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.     Yes

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.     Yes

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: 05/14/2018

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