Syndromic Surveillance Report

[NCIPC] Performance Monitoring of CDC’s Comprehensive Suicide Prevention Program

Documents and Forms

Document Name Document Type
Syndromic Surveillance Report Form and Instruction
Syndromic Surveillance Report Att F 0920-1368 CSP Syn Surv Rpt.docx Form and Instruction
Att F1 0920-1368 CSP SynSurRpt Screenshots.docx Syndromic Surveillance Report (screenshots) IC Document

Information Collection (IC) Details

IC Title:	Syndromic Surveillance Report	Agency IC Tracking Number:	0920-1368

Is this a Common Form? No		IC Status: New

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	n/a	Syndromic Surveillance Report	Att F 0920-1368 CSP Syn Surv Rpt.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 24	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	96	96
Annual IC Time Burden (Hours)	192	192
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Syndromic Surveillance Report (screenshots)	Att F1 0920-1368 CSP SynSurRpt Screenshots.docx	09/11/2025

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.