OMB control number

Chronic Q Fever in the United States: Enhanced Clinical Surveillance

OMB 0920-1305 · HHS/CDC.

OMB 0920-1305

The goal of this tool is to establish enhanced medical surveillance for chronic Q fever by gathering additional and more specific clinical data not otherwise collected during the course of routine public health surveillance for chronic Q fever. This information will allow for better characterization of the clinical presentation and risk factors of chronic Q fever in the United States and help educate physicians on identifying and diagnosing these cases.

The latest form for Chronic Q Fever in the United States: Enhanced Clinical Surveillance expires 2026-11-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form 0920-1305 Chronic Q Fever Enhanced Surveillance (Follow-up0 Form
Form 0920-1305 Chronic Q Fever-Enhanced Surveillance Report Form Form
Att 5 Consent Script.docx Supplementary Document
Att 9 Human Subjects Determination.pdf Supplementary Document
Att 8 Privacy Impact Assessment.pdf Supplementary Document
Att 2 60-Day FRN.pdf Supplementary Document
Att 1 - Authorizing Legislation-Section 301 of the Public Health Service Act (42 USC 241).pdf Supplementary Document
SSB.docx Supporting Statement B
SSA.docx Supporting Statement A
Chronic Q Fever Enhanced Surveillance (Follow-up0 Form
Chronic Q Fever-Enhanced Surveillance Report Form Form

All Historical Document Collections

202309-0920-006 Approved without change	Revision of a currently approved collection	2023-09-26
202004-0920-010 Approved without change	New collection (Request for a new OMB Control Number)	2020-05-29

OMB Details

Chronic Q Fever-Enhanced Surveillance Report Form

Federal Enterprise Architecture: Health - Public Health Monitoring

Form 0920-1305

Q Fever Case Report

Fillable Fileable

Form

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