Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
ABCs Neonatal Infection Expanded Tracking Form Unchanged 370 123 0 Form none Neonatal Tracking
Att 10_CDI Case Report Form New 16500 5500 0 Form None Clostridium Difficile Infection (CDI) Surveillance Emerging Infections Program Case Report
Att 11_CDI Treatment Form New 16500 2750 0 Form None EIP CDI Surveillance: CDI Case Treatment Questionnaire
Att 14_CDI Screening Form New 600 50 0 Form None Screening Questions for Clostridium difficile Telephone Interview
Att 15_CDI Telephone Interview New 500 333 0 Form None Community-associated Clostridium difficle Infection (CDI Surveillance Health Inter
Att 1_ABCs Case Report Form Modified 8090 2697 0 Form CDC 52.15A 2015 Active Bacterial Core Surveillance (ABCs) Case Report
Att 2_ABCs Invasive Pneumococcal Disease in Children Modified 220 36 0 Form None Active Bacterial Core Surveillance (ABCs) Invasive Pneumococcal Disease in Children
Att 3_2015 Active Bacterial Core Surveillance (ABCs) Case Report Non-Bacteremic Pneumoccoccal Disease New 1000 167 0 Form CDC 52.15A 2015 Active Bacterial Core Surveillance (ABCs) Case Report Non-Bacteremic Pneumococcal Disease
Att 5_FluSurv-NET Influenza Hospitalization Surveilance Project Case Report Form Modified 4000 1000 0 Form none FluSurv-NET Case Report
Att 6_2014-15 Vaccination History Patient/Proxy Interview Modified 1000 83 0 Form none Att 6_2014-15 Vaccination History Patient/Proxy Interview (English)
Att 8_FluSurv-Net Project Consent Form Modified 1000 83 0 Form None Verbal Consent Form
Att16_Resistant Gram-Negative Bacilli Case Report Form New 5000 1667 0 Form None 2015 Multi-site Gram-Negative Surveillance Initiative (MuGSI) Healthcare Associated Infection Community Interface (HAIC) Case Report
Campylobacter Unchanged 6370 2123 0 Other-WORD
Cryptosporidium Unchanged 1300 217 0 Other-WORD
Cyclospora Unchanged 30 5 0 Other-WORD
Hemolytic Uremic Syndrome (HUS) Unchanged 100 100 0 Other-WORD
Invasive Methicillin - Resistant - Staphylococcus aureus ABCs Case Report Form Unchanged 6090 2030 0 Form none Invasive Methicillin-Resistant Staph
Legionellosis ABCs Case Report Unchanged 1000 333 0 Form none Legionellosis Case Report
Listeria monocytogenes Unchanged 130 43 0 Other-WORD
Salmonella Unchanged 8270 2757 0 Other-WORD
Shiga toxin producing E. coli Unchanged 900 300 0 Other-WORD
Shigella Unchanged 1780 297 0 Other-WORD
Vibrio Unchanged 200 33 0 Other-WORD
Yersinia Unchanged 160 27 0 Other-WORD
Total burden requested under this ICR: 81110 22754 0  
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