Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
ABCs Case Report Form Unchanged 8090 2697 0 Form none ABCsCRF 2015
ABCs Invasive Pneumococcal Disease in Children Unchanged 220 37 0 Form none Invasive Pneumococcal 2015
ABCs Neonatal Infection Expanded Tracking Form Unchanged 370 123 0 Form none Neonatal Tracking
ABCs Non Bacteremic Pneumococcal Disease Unchanged 1000 167 0 Form none Non Bacteremic Pneumococcal 2015
CDI Case Report Form New 16500 5500 0 Form NA Clostridium Difficile Infection (CDI) Surveillance Emerging Infections Program Case Report
CDI Screening Form New 600 50 0 Other-Interview Screen
CDI Telephone Interview New 500 333 0 Other-Telephone Interview
CDI Treatment Form New 16500 2750 0 Form NA EIP CDI Surveillance: CDI Case Treatment Questionnaire
Campylobacter Unchanged 6370 2123 0 Other-WORD
Cryptosporidium Unchanged 1300 217 0 Other-WORD
Cyclospora Unchanged 30 5 0 Other-WORD
FluSurv-NET Influenza Hospitalization Surveilance Project Case Report Form Unchanged 4000 1000 0 Form none FluSurv-NET Influenza Hospital Surveillance Project
FluSurv-Net Project Consent Form Unchanged 1000 83 0 Form none Consent
Hemolytic Uremic Syndrome (HUS) Unchanged 100 100 0 Other-WORD
Influenza Hospitalization Surveillance Project Vaccination Telephone Survey Unchanged 1000 83 0 Form none Vaccination Telephone Survey - English
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
Resistant Gram-Negative Bacilli Case Report Form New 5000 1667 0 Form NA 2015 Multi-site Gram-Negative Surveillance Initiative (MuGSI) Healthcare Associated Infection Community Interface (HAIC) Case Report
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 22755 0  
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