OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

[NCSTLTPHIW] Information Collections to Advance State, Tribal, Local and Territorial (STLT) Governmental Agency System Performance, Capacity, and Program Delivery

OMB 0920-0879 · HHS/CDC.

OMB 0920-0879

CDC requests an Extension to the Generic Clearance to continue to collect information related to domestic public health issues and services that affect state, tribal, local, and territorial STLT governmental entities. The Extension ICR includes a list of GENIC projects that were approved in the previous clearance period (January 2021-June 2023). Also noted [see ICR Summary of Burden, below]: There is a significant reduction in Total Cost Burden for this Extension. In the previous clearance period, CDC reported the figure calculated in SSA.12. In this Extension, per guidance from HHS, CDC is reporting the dollar amount ($0) calculated in SSA.13 This Non-Substantive Change Request is submitted to amend a previously approved GenIC (Use and Acceptability of the Model Aquatic Health Code 2024) to increase the number of focus groups from three to six and to keep the survey open for an additional two weeks..The objective, scope, and questions for the focus group will not change, and increasing the number of focus groups will not impact the overall burden approved for this generic information collection, as it would reallocate 17 burden hours from the MAHC Use and Acceptability Survey to the Focus Group.

The latest form for [NCSTLTPHIW] Information Collections to Advance State, Tribal, Local and Territorial (STLT) Governmental Agency System Performance, Capacity, and Program Delivery expires 2026-08-31 and can be found here.

Latest Forms, Documents, and Supporting Material
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Name
Form and Instruction
Form and Instruction
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Form and Instruction
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Form and Instruction
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Supplementary Document
Supplementary Document
Justification for No Material/Nonsubstantive Change
Justification for No Material/Nonsubstantive Change
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Supporting Statement B
Supporting Statement B
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Supporting Statement A
All Historical Document Collections
 No material or nonsubstantive change to a currently approved collection 2024-10-16
Approved without change
 Extension without change of a currently approved collection 2023-06-30
Extension without change of a currently approved collection 2020-11-30
Approved without change
 Extension without change of a currently approved collection 2017-11-21
Withdrawn and continue
 Extension without change of a currently approved collection 2017-08-28
Approved without change
 Revision of a currently approved collection 2015-01-05
Approved without change
 Revision of a currently approved collection 2014-02-28
Approved without change
 No material or nonsubstantive change to a currently approved collection 2011-10-13
Approved with change
 New collection (Request for a new OMB Control Number) 2011-02-02
OMB Details

[PHIC/NCIRD] Pediatric Hepatitis-Adenovirus Case Control Evaluation, United States 2022-2026 (24CN)

Federal Enterprise Architecture: Health - Illness Prevention

Form 0920-0879Hepatitis pediátrica de etiología desconocida - Cuestionario sobre exposiciones (entrevista a los padres)Fillable FileableForm and instruction
Form 0920-0879Hepatitis pediátrica de etiología desconocida. CONTROL del cuestionario sobre exposiciones (Entrevista a los padres)Fillable FileableForm and instruction
Form 0920-0879Pediatric Hepatitis of Unknown Etiology - Exposures Questionnaire CONTROL (Parental Interview)Fillable FileableForm and instruction
Form 0920-0879Pediatric Hepatitis of Unknown Etiology - Exposures Questionnaire (Parental Interview)Fillable FileableForm and instruction
Form 0920-0879PEDIATRIC HEPATITIS OF UNKNOWN ETIOLOGY MEDICAL RECORD ABSTRACTION FORMFillable FileableForm and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.