Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
ABCs Case Report Form Unchanged 8090 2697 0 Form and Instruction 17AHK
ABCs H. Influenzae Neonatal Sepsis Expanded Surveillance Form Modified 60 10 0 Form and Instruction 17AHK
ABCs Invasive Pneumococcal Disease in Children Unchanged 220 37 0 Form and Instruction 17AHK
ABCs Neonatal Infection Expanded Tracking Form Unchanged 370 123 0 Form and Instruction 17AHK
ABCs Severe GAS Infection Supplemental Form New 1360 453 0 Form 0920-0978
ABCs Surveillance for Non-Invasive Pneumococcal Pneumonia (SNiPP) Case Report Form Modified 1250 208 0 Form none
Form CDC
FluSurv-Net Project Consent Form Removed 0 0 0 Form none
FoodNet Campylobacter Modified 8500 2975 0 Form 0920-0978
FoodNet Cryptosporidium Modified 1300 217 0 Form 0920-0978
FoodNet Cyclospora Modified 30 5 0 Form 0920-0978
FoodNet Hemolytic Uremic Syndrome (HUS) Modified 100 100 0 Form NA
FoodNet Listeria monocytogenes Modified 130 43 0 Form 0920-0978
FoodNet Salmonella Modified 8270 2895 0 Form 0920-0978
FoodNet Shiga toxin producing E. coli Modified 1900 633 0 Form 0920-0978
FoodNet Shigella Modified 2900 483 0 Form 0920-0978
FoodNet Vibrio Modified 250 42 0 Form 0920-0978
FoodNet Yersinia Modified 300 50 0 Form 0920-0978
HAIC CDI Case Report Form Modified 16500 8250 0 Form 0920-0978
HAIC Candidemia Case Report Form New 7200 2400 0 Form and Instruction 0920-0978
HAIC Invasive Methicillin-Sensitive Staphylococcus aureus (MSSA) New 10350 3450 0 Form and Instruction 0920-0978
HAIC Invasive Methicillin-resistant Staphylococcus aureus (MRSA) Modified 6090 2030 0 Form 0920-0978
HAIC Multi-Site Gram-Negative Bacilli Case Report Form (MuGSI-CRE/CRAB) Modified 5000 1667 0 Form NA
Form VERSION:01-2016
Form VERSION: 11/2017
Form 0920-09078
HAIC Multi-Site Gram-Negative Bacilli Case Report Form for Carbapenem-Resistant Pseudomonas ajeruginosa (CR-PA) New 3440 2580 0 Form 0920-0978
HAIC Multi-Site Gram-Negative Surveillance Initiative - Extended Spectrum Beta-Lactamase Producing Enterobacteriaceae (MuGSI-ESBL) New 12000 4000 0 Form and Instruction 0920-0978
Influenza Hospitalization Surveilance Network Case Report Form Modified 10000 4167 0 Form 0920-0978
Influenza Hospitalization Surveillance Project Provider Vaccination History Fax Form (Children/Adults) New 3330 278 0 Form and Instruction 0920-0978
Influenza Hospitalization Surveillance Project Vaccination Telephone Script / Consent Form (English) Modified 3330 278 0 Form and Instruction 0920-0978
Form and Instruction 0920-0978
Influenza Hospitalization Surveillance Project Vaccination Telephone Script / Consent Form (Spanish) New 3330 278 0 Form and Instruction 0920-0978
Form and Instruction 0920-0978
Total burden requested under this ICR: 115600 40349 0  
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