Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
2015 ABCs H. Influenzae Neonatal Sepsis Expanded Surveillance Form New 60 10 0 Form CDC 10-2015
ABCs Case Report Form Modified 8090 2697 0 Form none
Form CDC 52.15A REV. 10-2015
ABCs Invasive Pneumococcal Disease in Children Unchanged 220 37 0 Form none
ABCs Neonatal Infection Expanded Tracking Form Unchanged 370 123 0 Form none
ABCs Non Bacteremic Pneumococcal Disease Modified 1250 208 0 Form none
Form CDC
CDI Case Report Form Modified 16500 5500 0 Form NA
Form CDC Rev.10-2015
CDI Screening Form Unchanged 600 50 0 Other-Interview Screen
CDI Telephone Interview Unchanged 500 333 0 Other-Telephone Interview
CDI Treatment Form Unchanged 16500 2750 0 Form NA
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 Modified 4000 1000 0 Form none
Form CDC Rev 07-2015
FluSurv-Net Project Consent Form Unchanged 1000 83 0 Form none
Hemolytic Uremic Syndrome (HUS) Unchanged 100 100 0 Other-WORD
Influenza Hospitalization Surveillance Project Vaccination Telephone Survey Unchanged 1000 83 0 Form none
Invasive Methicillin - Resistant - Staphylococcus aureus ABCs Case Report Form Modified 6090 2030 0 Form none
Form CDC 52.15B Rev 10-2015
Legionellosis ABCs Case Report Unchanged 1000 333 0 Form none
Listeria monocytogenes Unchanged 130 43 0 Other-WORD
Resistant Gram-Negative Bacilli Case Report Form Modified 5000 1667 0 Form NA
Form VERSION:01-2016
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: 81420 22806 0  
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