Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
2015 ABCs H. Influenzae Neonatal Sepsis Expanded Surveillance Form Unchanged 60 10 0 Form CDC 10-2015 2015 ABCs H. Influenzae Neonatal Sepsis Expanded Surveillance Form
ABCs Case Report Form Unchanged 8090 2697 0 Form none ABCsCRF 2015
Form CDC 52.15A REV. 10-2015 2016 Active Bacterial Core Surveillance (ABCs) CASE REPORT
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 1250 208 0 Form none Non Bacteremic Pneumococcal 2015
Form CDC 2016 Surveillance for Non-Invasive Penumococcal Pneumonia (SNiPP)
CDI Case Report Form Modified 16500 5500 0 Form NA Clostridium Difficile Infection (CDI) Surveillance Emerging Infections Program Case Report
Form CDC Rev.10-2015 Clostridium Difficile Infection (CDI) Surveillance Emerging Infections Program Case Report
Form CDC Rev 09-2016 CLOSTRIDIUM DIFFICILE INFECTION (CDI) SURVEILLANCE EMERGING INFECTIONS PROGRAM CASE REPORT
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 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
Form CDC Rev 07-2015 2015-16 FluSurv-NET Influenza Hospitalization Surveillance Project Case Report Form
FluSurv-Net Project Consent Form Unchanged 1000 83 0 Form none Consent
Hemolytic Uremic Syndrome (HUS) Modified 100 100 0 Form NA FoodNet Hemolytic Uremic Syndrome (HUS) Surveillance
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 Modified 6090 2030 0 Form none Invasive Methicillin-Resistant Staph
Form CDC 52.15B Rev 10-2015 Healthcare-Associated Infections Community Interface (HACI) Case Report -2016
Form CDC 52.15B Rev 09-2016 Invasive Methicillin-Resistant Staphylococcus aureus HAIC Case Report - 2017
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 Modified 5000 1667 0 Form NA 2015 Multi-site Gram-Negative Surveillance Initiative (MuGSI) Healthcare Associated Infection Community Interface (HAIC) Case Report
Form VERSION:01-2016 2016 Multi-site Gram Negative Surveillance Initiative (MuGSI) Healthcare Associated Infection Community Interface (HAIC) Case Report
Form VERSION: 11/2017 2017 Multi-site Gram-Negative Surveillance Initiative (MuGSI) 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: 81420 22806 0  
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