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Record Abstraction (STD Clinics)
[NCHHSTP] The STD Surveillance Network (SSuN)
OMB: 0920-1072
IC ID: 232378
OMB.report
HHS/CDC
OMB 0920-1072
ICR 202306-0920-010
IC 232378
( )
Documents and Forms
Document Name
Document Type
Form 0920-1072
Record Abstraction (STD Clinics)
Form and Instruction
0920-1072 SSuN Data Elements
Att5_DataElements_DataDisctionary.pdf
Form and Instruction
0920-1072 SSuN Data Elements
Att5_DataElements_DataDisctionary.pdf
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Record Abstraction (STD Clinics)
Agency IC Tracking Number:
0920-1072
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Required to Obtain or Retain Benefits
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
SSuN Data Elements
Att5_DataElements_DataDisctionary.pdf
Yes
Yes
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:
40
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
100 %
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
240
0
229
0
0
11
Annual IC Time Burden (Hours)
960
0
696
0
0
264
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.