Viral Gastroenteritis Outbreak Submission Form

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

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Viral Gastroenteritis Outbreak Submission Form Form
Viral Gastroenteritis Outbreak Submission Form Attachment Y Viral Gastroenteritis Outbreak Submission Form.pdf Form
Viral Gastroenteritis Outbreak Submission Form Attachment Y Viral Gastroenteritis Outbreak Submission Form.pdf Form

Information Collection (IC) Details

IC Title:	Viral Gastroenteritis Outbreak Submission Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	None	Viral Gastroenteritis Outbreak Submission Form	Attachment Y Viral Gastroenteritis Outbreak Submission Form.pdf	NA	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 62812

Number of Respondents: 20	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	8	8
Annual IC Cost Burden (Dollars)	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.