Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
ABCs Case Report Form Modified 8090 2697 0 Form and Instruction 0920-0978
ABCs H. Influenzae Neonatal Sepsis Expanded Surveillance Form Modified 60 10 0 Form and Instruction 0920-0978
ABCs Invasive Pneumococcal Disease in Children Modified 220 37 0 Form and Instruction 0920-0978
ABCs Neonatal Infection Expanded Tracking Form Modified 370 123 0 Form and Instruction 0920-0978
ABCs Severe GAS Infection Supplemental Form Modified 1360 453 0 Form and Instruction 0920-0978
Flu Surv NET Laboratory Survey New 230 38 0 Form and Instruction 0920-0978
FoodNet Campylobacter Modified 9420 3297 0 Form and Instruction 0920-0978
FoodNet Cryptosporidium Removed 0 0 0 Form 0920-0978
FoodNet Cyclospora Modified 1630 272 0 Form and Instruction 0920-0978
FoodNet Hemolytic Uremic Syndrome (HUS) Modified 100 100 0 Form and Instruction 0920-0978
FoodNet Listeria monocytogenes Modified 150 50 0 Form and Instruction 0920-0978
FoodNet Salmonella Modified 7890 2761 0 Form and Instruction 0920-0978
FoodNet Shiga toxin producing E. coli Modified 2050 683 0 Form and Instruction 0920-0978
FoodNet Shigella Modified 2130 355 0 Form and Instruction 0920-0978
FoodNet Vibrio Modified 340 56 0 Form and Instruction 0920-0978
FoodNet Yersinia Modified 480 80 0 Form and Instruction 0920-0978
Foodnet Clinical Laboratory Practices and Testing Volume New 700 233 0 Form and Instruction 0920-0978
HAIC CDI Annual Laboratory Survey New 160 27 0 Form and Instruction 0920-0978
HAIC CDI Annual Surveillance Officers Survey New 10 3 0 Form and Instruction 0920-0978
HAIC CDI Case Report Form Modified 16500 9625 0 Form and Instruction 0920-0978
HAIC CDI LTCF Survey New 450 38 0 Form and Instruction 0920-0978
HAIC Candidemia Case Report Form Modified 7200 2400 0 Form and Instruction 0920-0978
HAIC Candidemia Periodic Laboratory Survey New 135 45 0 Form and Instruction 0920-0978
HAIC Invasive Methicillin-Sensitive Staphylococcus aureus (MSSA) Modified 7540 3142 0 Form and Instruction 0920-0978
HAIC Invasive Methicillin-resistant Staphylococcus aureus (MRSA) Modified 4740 1975 0 Form and Instruction 0920-0978
HAIC Invasive Staphylococcus aureus Annual Laboratory Survey New 110 15 0 Form and Instruction 0920-0978
HAIC Invasive Staphylococcus aureus Annual Surveillance Officers Survey New 10 2 0 Form and Instruction 0920-0978
HAIC Multi-Site Gram-Negative Bacilli Case Report Form (MuGSI-CRE/CRAB) Modified 5000 2083 0 Form and Instruction 0920-0978
HAIC Multi-Site Gram-Negative Surveillance Initiative - Extended Spectrum Beta-Lactamase Producing Enterobacteriaceae (MuGSI-ESBL) Modified 12000 5000 0 Form and Instruction 0920-0978
Influenza Hospitalization Surveilance Network Case Report Form Modified 10000 4167 0 Form and Instruction 0920-0978
Influenza Hospitalization Surveillance Project Provider Vaccination History Fax Form (Children/Adults) Modified 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) Modified 3330 278 0 Form and Instruction 0920-0978
Form and Instruction 0920-0978
Total burden requested under this ICR: 109065 40601 0  
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