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 0920-0978 2020 ABC Surveillance Case Report
ABCs H. Influenzae Neonatal Sepsis Expanded Surveillance Form Unchanged 60 10 0 Form and Instruction 0920-0978 ABC H. Influenzae Neonatal Sepsis Expanded Surveillance Form
ABCs Invasive Pneumococcal Disease in Children Unchanged 220 37 0 Form and Instruction 0920-0978 ABC Invasive Pneumococcal Disease in Children (age>2 months to <5 years
ABCs Neonatal Infection Expanded Tracking Form Unchanged 370 123 0 Form and Instruction 0920-0978 ABC Neonatal Infection Expanded Tracking Form
ABCs Severe GAS Infection Supplemental Form Unchanged 1360 453 0 Form and Instruction 0920-0978 ABC Severe GAS Infection Supplemental Form
COVID-19 - CDI Case Report and Treatment Form Removed 0 0 0 Form and Instruction 0920-0978 COVID-19 CLOSTRIDIOIDES DIFFICILE INFECTION (CDI) SURVEILLANCE
COVID-19 - Invasive Methicillin-resistant Staphylococcus aureus (MRSA) Infection Case Report Form Removed 0 0 0 Form and Instruction 0920-0978 COVID-19 Invasive Methicillin-Resistant Staphylococcus aureus Healthcare-Associated Infections Community Interface (HAIC) Case Report – 2020
COVID-19 - Invasive Methicillin-sensitive Staphylococcus aureus (MSSA) Infection Case Report Form Removed 0 0 0 Form and Instruction 0920-0978 COVID -19 Invasive Methicillin-Sensitive Staphylococcus aureus Healthcare-Associated Infections Community Interface (HAIC) Case Report – 2020
COVID-19 - MuGSI Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae (ESBL) Removed 0 0 0 Form and Instruction 0920-0978 COVID-19 42020 Extended-Spectrum Beta-Lactamase (ESBL)-Producing Enterobacteriaceae MuGSI-HAIC
COVID-19 - MuGSI Case Report Form for Carbapenem-resistant Enterobacteriaceae (CRE) and Acinetobacter baumannii (CRAB) Removed 0 0 0 Form and Instruction 0920-0978 COVID-19 - Carbapenem Resistant Enterobacteriaceae (CRE)/ Carbapenem Resistant A. baumannii (CRAB) MUGSI-HAIC
Flu Surv NET Laboratory Survey Unchanged 230 38 0 Form and Instruction 0920-0978 FluSurv-NET Laboratory Survey 2019-2020 Season
FoodNet Campylobacter Unchanged 9420 3297 0 Form and Instruction 0920-0978 FoodNet Active Surveillance Variable List
FoodNet Cyclospora Unchanged 1630 272 0 Form and Instruction 0920-0978 FoodNet Active Surveillance Variable List
FoodNet Hemolytic Uremic Syndrome (HUS) Unchanged 100 100 0 Form and Instruction 0920-0978 FoodNet HUS CRF
FoodNet Listeria monocytogenes Unchanged 150 50 0 Form and Instruction 0920-0978 FoodNet Active Surveillance Variable List
FoodNet Salmonella Unchanged 7890 2761 0 Form and Instruction 0920-0978 FoodNet Active Surveillance Variable List
FoodNet Shiga toxin producing E. coli Unchanged 2050 683 0 Form and Instruction 0920-0978 FoodNet Active Surveillance Variable List 2019-2020
FoodNet Shigella Unchanged 2130 355 0 Form and Instruction 0920-0978 FoodNet Active Surveillance Variable List
FoodNet Vibrio Unchanged 340 56 0 Form and Instruction 0920-0978 FoodNet Active Surveillance Variable List
FoodNet Yersinia Unchanged 480 80 0 Form and Instruction 0920-0978 Foodborne and DIarrheal Diseases Message Mapping Guide (FDD MMG - FoodNet only portion)
Foodnet Clinical Laboratory Practices and Testing Volume Unchanged 700 233 0 Form and Instruction 0920-0978 Foodnet Lab Practices Volume
HAIC CDI Annual Laboratory Survey Unchanged 160 40 0 Form and Instruction 0920-0978 Annual Survey of Laboratory Testing Practices for C. difficile Infection
HAIC CDI Annual Surveillance Officers Survey Unchanged 10 3 0 Form and Instruction 0920-0978 Surveillance Officer's Survey
HAIC CDI Case Report Form Modified 16500 10450 0 Form and Instruction 0920-0978 Clostridioides Difficile Infection (CDI Surveillance Emerging Infections Program Case Report
HAIC CDI LTCF Survey Unchanged 450 38 0 Form and Instruction 0920-0978 Emerging Infections Progrom C. difficile Surveillance Nuring Home Telephone Call Survey
HAIC Candidemia Case Report Form Unchanged 2000 1000 0 Form and Instruction 0920-0978 Candidemia 2020 Case Report Form
HAIC Candidemia Periodic Laboratory Survey Unchanged 135 45 0 Form and Instruction 0920-0978 2020 Laboratory Testing Practices for Candidemia Questionnaire
HAIC Invasive Methicillin-Sensitive Staphylococcus aureus (MSSA) Modified 5840 2725 0 Form and Instruction 0920-0978 Invasive Methicillin-Sensitive Staphylococcus aureau (HAIC) Case Report 2020
HAIC Invasive Methicillin-resistant Staphylococcus aureus (MRSA) Modified 3400 1587 0 Form and Instruction 0920-0978 Invasive Methicillin-Resistant Staphylococcus aureus (MRSA) HAIC Case Report
HAIC Invasive Staphylococcus aureus Annual Laboratory Survey Unchanged 110 37 0 Form and Instruction 0920-0978 HAIC Staphylococcus aureus Laboratory Survey: Use of Nucleic Acid Amplificaiton Testing (NAAT)
HAIC Invasive Staphylococcus aureus Annual Surveillance Officers Survey Unchanged 100 17 0 Form and Instruction 0920-0978 2019 HAIC Invasive Staphylococcus aureus Supplemental Surveiallance Officer Survey
HAIC Multi-Site Gram-Negative Bacilli Case Report Form (MuGSI-CRE/CRAB) Modified 5000 2333 0 Form and Instruction 0920-0978 2020 Carbapenem Resistant Enterobacteriaceae (CRE) Carbapenem Resistant A. baumannii (CRAB) Multi-site Gram-Negative Bacilli Case Report Form (MuGSI-CRE/CRAB)
HAIC Multi-Site Gram-Negative Surveillance Initiative - Extended Spectrum Beta-Lactamase Producing Enterobacteriaceae (MuGSI-ESBL) Modified 11040 5152 0 Form and Instruction 0920-0978 2020 Extended-Spectrum Beta-Lactamase (ESBL)- Producting Enterobacteriaceae MuGSI (HAIC)
Influenza Hospitalization Surveilance Network Case Report Form Unchanged 10000 4167 0 Form and Instruction 0920-0978 2019-2020 FluSurv-NET Influenza Hospitalization Surveillance Project Case Report Form
Influenza Hospitalization Surveillance Project Provider Vaccination History Fax Form (Children/Adults) Unchanged 3330 278 0 Form and Instruction 0920-0978 FluSurv Net Provider Vaccination History Fax Form
Influenza Hospitalization Surveillance Project Vaccination Telephone Script / Consent Form (English) Unchanged 3330 278 0 Form and Instruction 0920-0978 FluSurv NET Vaccination Phone Script
Form and Instruction 0920-0978 FluSurv NET Consent From English
Influenza Hospitalization Surveillance Project Vaccination Telephone Script / Consent Form (Spanish) Unchanged 3330 278 0 Form and Instruction 0920-0978 FluSurv NET Vaccination Phone Script
Form and Instruction 0920-0978 FluSurv NET Consent Form Spanish
Total burden requested under this ICR: 99955 39673 0  
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