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Content on this page was developed during the 2009-2010 H1N1 pandemic and has not been updated.

  • The H1N1 virus that caused that pandemic is now a regular human flu virus and continues to circulate seasonally worldwide.
  • The English language content on this website is being archived for historic and reference purposes only.
  • For current, updated information on seasonal flu, including information about H1N1, see the CDC Seasonal Flu website.

Novel Influenza A (H1N1)-Related School Dismissal Reporting Form

April 9, 2010 11:30 AM ET

The 2009 H1N1 School Dismissal Monitoring System is no longer active. No submissions will be accepted, processed, or responded to. This page and its contents are being provided for historical purposes only.

The Centers for Disease Control and Prevention and the U. S. Department of Education have established a School Dismissal Monitoring System to report on novel influenza A (H1N1)-related school or school district dismissals in the United States. Your assistance in reporting known school dismissals is very important.


  • For district-wide dismissals, only provide the name of the school district. It is not necessary to list all the individual schools in the school district.
  • For single school dismissals, provide the name of only the individual school.
  • For multiple school dismissals (but not district-wide), complete a separate form for each school.

OMB Control No. 0920-0008
Exp. Date 03/31/2010

Required *

Name of school
or school district:*
Zip code of school
or school district:*
(5 Digit Format)
Date school or school
district dismissed:*
Date school or school
district is projected
to re-open: (if known)



Name of person
submitting this form:

Public reporting burden of this collection of information is estimated to average 2 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB Control Number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA 0920-0008.

Contact Us:
  • Centers for Disease Control and Prevention
    1600 Clifton Rd
    Atlanta, GA 30333
  • 800-CDC-INFO
    TTY: (888) 232-6348
  • Contact CDC-INFO The U.S. Government's Official Web PortalDepartment of Health and Human Services
Centers for Disease Control and Prevention   1600 Clifton Road Atlanta, GA 30329-4027, USA
800-CDC-INFO (800-232-4636) TTY: (888) 232-6348 - Contact CDC–INFO
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