[NCIRD] National Disease Surveillance Program - II. Disease Summaries

ICR 202301-0920-009

OMB: 0920-0004

Federal Form Document

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0920-0004 can be found here:

2024-05-07 - No material or nonsubstantive change to a currently approved collection

Forms and Documents

Document Name	Status
US WHO Colloborating Laboratories Influenza Testing Methods Assessment Form	Modified
Arthropod (Vector)-Borne Diseases (Non-Human Data) Form and Instruction	New
Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Form (CRF) Form and Instruction	New
Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Short Form Form and Instruction	New
Aggregate counts of persons exposed to Highly Pathogenic Avian Influenza (HPAI Form and Instruction	New
Suspect Respiratory Virus Patient Form Form	Modified
Form CDC 55.20E U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) Workfolder_CDC 55.20E Form	Modified
Middle East Respiratory Syndrome Coronavirus (MERS) Patient Under Investigation (PUI) Form Form	Modified
Adenovirus Typing Report Form Form	Modified
Antiviral Resistant Influenza Infection Case Report Form Form	Modified
Human Infections with Novel Influenza A Virus Severe Outcomes Form	Modified
Form CDC 55.20 Att G US Outpatient Influenza-like Illness Surveillance Network (ILINet) Weekly Form	Removed
Influenza Associated Pediatric Mortality Case Report Form Form	Modified
WHO Collaborating Center for Influenza Virus Surveillance Form	Modified
Human Infection with Novel Influenza A Virus Case Report Form Form	Modified
Novel Influenza A Virus Case Screening Form Form	Modified
Viral Gastroenteritis Outbreak Submission Form Form	Modified
Form CDC 52.12 Att Z_ Waterborne Diseases Transmission Form	Removed
Form CDC 52.13 Att D_NORS Foodborne Disease Transmission_ Person to Person Disease Transmission_Animal Contact_Environmental Contamination_Unknown Transmission Mode Form	Removed
Form CDC 55.83A National Respiratory and Enteric Virus Surveillance System (NREVSS) Laboratory Assessment Form	Modified
Form CDC 55.90 National Enterovirus Surveillance Report 55.9 Form	Modified
Attachment DD 103122NL-NR.pdf Supplementary Document	2023-01-26
Attachment C_Disease Summaries 0920-0004 _2023 FINAL_final.docx Supplementary Document	2023-01-26
Attachment B 60 Day Federal Register Notice.pdf Supplementary Document	2023-01-26
Authorizing Legislation.pdf Supplementary Document	2023-01-26
SSB 0920-0004 REINSTATEMENT 2023 FINAL.docx Supporting Statement B	2023-01-26
SSA 0920-0004 REINSTATEMENT 2023 FINAL_final.docx Supporting Statement A	2023-01-26

IC Document Collections

IC ID	Document Title	Status
37707	US WHO Colloborating Laboratories Influenza Testing Methods Assessment Form	Modified
258096	Arthropod (Vector)-Borne Diseases (Non-Human Data) Form and Instruction	New
258095	Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Form (CRF) Form and Instruction	New
258094	Pediatric Hepatitis of Unknown Etiology Medical Record Abstraction Short Form Form and Instruction	New
258093	Aggregate counts of persons exposed to Highly Pathogenic Avian Influenza (HPAI Form and Instruction	New
228082	Suspect Respiratory Virus Patient Form Form	Modified
228068	U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) Workfolder_CDC 55.20E Form	Modified
212473	Middle East Respiratory Syndrome Coronavirus (MERS) Patient Under Investigation (PUI) Form Form	Modified
212472	Adenovirus Typing Report Form Form	Modified
212471	Antiviral Resistant Influenza Infection Case Report Form Form	Modified
212470	Human Infections with Novel Influenza A Virus Severe Outcomes Form	Modified
199056	Att G US Outpatient Influenza-like Illness Surveillance Network (ILINet) Weekly Form	Removed
199052	Influenza Virus Electronic year round PHIN-MS Other-Variables for Reporting	Modified
199051	Influenza Virus Electronic year round - PHLIP_HL7 Messaging Data Elements Other-Variables for Electronic Reporting	Modified
199050	Influenza Associated Pediatric Mortality Case Report Form Form	Modified
199049	WHO Collaborating Center for Influenza Virus Surveillance Form	Modified
199043	Human Infection with Novel Influenza A Virus Case Report Form Form	Modified
199040	Novel Influenza A Virus Case Screening Form Form	Modified
178374	Viral Gastroenteritis Outbreak Submission Form Form	Modified
178372	Att Z_ Waterborne Diseases Transmission Form	Removed
178369	Att D_NORS Foodborne Disease Transmission_ Person to Person Disease Transmission_Animal Contact_Environmental Contamination_Unknown Transmission Mode Form	Removed
178365	National Respiratory and Enteric Virus Surveillance System (NREVSS) Laboratory Assessment Form	Modified
178364	National Enterovirus Surveillance Report 55.9 Form	Modified

ICR Details