Human Infections with Novel Influenza A Virus Severe Outcomes

[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⚠️ Notice: This information collection may be referencing outdated material.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
Human Infections with Novel Influenza A Virus Severe Outcomes Form
Human Infection with Novel Influenza A Virus Severe Outc Attachment M Human Infection with Novel Influenza A Virus Severe Outcomes.pdf Form
Human Infection with Novel Influenza A Virus Severe Outc Attachment M Human Infection with Novel Influenza A Virus Severe Outcomes.pdf Form

Information Collection (IC) Details

IC Title:	Human Infections with Novel Influenza A Virus Severe Outcomes	Agency IC Tracking Number:	0920-0004

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	Human Infection with Novel Influenza A Virus Severe Outcomes	Attachment M Human Infection with Novel Influenza A Virus Severe Outcomes.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 57	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	57	57
Annual IC Time Burden (Hours)	86	86
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.