CDC 55.20 US Outpatient Influenza-like Illness Surveillance Networ

Form Approved
OMB No. 0920-0004

US Outpatient Influenza-like Illness
Surveillance Network (ILINet) Weekly,
(CDC 55.20)
Report for the 7-day period ending
Check if
revised
report

_____/_____/_____
ID Number

Number of
Patients with
ILI

Total Number
Patients Seen in
Age Group

0-4 years
Influenza-like Illness
Fever (100 F [37.8 C], oral or
equivalent)
-AND cough and/or sore throat
(in the absence of a known cause).

5-24 years

25-49 years
50-64 yrs
>64 yrs.

Note:
There is no requirement for a
positive influenza test (i.e. rapid
antigen test) when determining the
number of patients with ILI.

Unknown
Total Number of Patients Seen for Any Reason
(Total of ILI + Non-ILI cases for all age groups combined)

DO NOT LEAVE THIS BLANK.
WITHOUT THIS NUMBER, THE REPORT CANNOT BE USED.
FAX THIS FORM TO 1-888-232-1322(NO COVER SHEET IS REQUIRED)
Public reporting burden of this collection of information is estimated to average 10 minutes per response, 
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the data needed, and completing and reviewing the collection of information. An agency may not conduct 
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of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information 
Collection Review Office, 1600 Clifton Road NE, MS D‐74, Atlanta, Georgia 30333; ATTN: PRA (0920‐0004).