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Early Syphilis Cases (Section 2)
Enhanced STD Surveillance Network
OMB: 0920-1072
IC ID: 232376
OMB.report
HHS/CDC
OMB 0920-1072
ICR 201807-0920-010
IC 232376
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1072 can be found here:
2023-08-01 - Revision of a currently approved collection
2020-04-30 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Form 0920-1072
Early Syphilis Cases (Section 2)
Form and Instruction
0920-1072 Early Syphilis Cases (Section 2)
Att 8_InterviewTemplate_GC_syphilis.pdf
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Early Syphilis Cases (Section 2)
Agency IC Tracking Number:
0920-1072
Is this a Common Form?
No
IC Status:
New
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
0920-1072
Early Syphilis Cases (Section 2)
Att 8_InterviewTemplate_GC_syphilis.pdf
NA
No
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
406
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
406
0
406
0
0
0
Annual IC Time Burden (Hours)
68
0
68
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.