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 Unchanged 60 10 0 Form and Instruction 0920-0978
ABCs Invasive Pneumococcal Disease in Children Unchanged 220 37 0 Form and Instruction 0920-0978
ABCs Neonatal Infection Expanded Tracking Form Unchanged 370 123 0 Form and Instruction none
ABCs Severe GAS Infection Supplemental Form Unchanged 1360 453 0 Form and Instruction 0920-0978
Flu Surv NET Laboratory Survey Modified 160 26 0 Form none
FoodNet Campylobacter Modified 9700 3395 0 Other-Variable list
FoodNet Cyclospora Modified 420 70 0 Other-Variable list
FoodNet Hemolytic Uremic Syndrome (HUS) Modified 100 100 0 Form and Instruction 0920-0978
FoodNet Listeria monocytogenes Modified 160 53 0 Other-Variable list
FoodNet Salmonella Modified 8550 2993 0 Other-Variable list
FoodNet Shiga toxin producing E. coli Modified 2900 967 0 Other-Variable list
FoodNet Shigella Modified 2340 390 0 Other-Variable list
FoodNet Vibrio Modified 460 77 0 Other-Variable list
FoodNet Yersinia Modified 550 92 0 Form and Instruction 0920-0978
Other-Variable list
Foodnet Clinical Laboratory Practices and Testing Volume Modified 700 233 0 Form and Instruction none
HAIC CDI Annual Laboratory Survey Modified 160 51 0 Form and Instruction n/a
HAIC CDI Annual Surveillance Officers Survey Modified 10 3 0 Form and Instruction 0920-0978
HAIC CDI Case Report Form Modified 16500 10450 0 Form and Instruction none
HAIC CDI LTCF Survey Unchanged 450 38 0 Form and Instruction 0920-0978
HAIC Candidemia Case Report Form Modified 1700 1134 0 Form and Instruction none
HAIC Candidemia Periodic Laboratory Survey Modified 200 40 0 Form and Instruction none
HAIC Invasive Methicillin-Sensitive Staphylococcus aureus (MSSA) Modified 5840 2725 0 Form and Instruction none
HAIC Invasive Methicillin-resistant Staphylococcus aureus (MRSA) Modified 3400 1587 0 Form and Instruction none
HAIC Invasive Staphylococcus aureus Annual Laboratory Survey Unchanged 110 37 0 Form and Instruction none
HAIC Invasive Staphylococcus aureus Annual Surveillance Officers Survey Modified 100 17 0 Form and Instruction 0920-0978
HAIC Multi-Site Gram-Negative Bacilli Case Report Form (MuGSI-CRE/CRAB) Unchanged 5000 2333 0 Form and Instruction n/a
HAIC Multi-Site Gram-Negative Surveillance Initiative - Extended Spectrum Beta-Lactamase Producing Enterobacteriaceae (MuGSI-ESBL) Unchanged 11040 5152 0 Form and Instruction n/a
Influenza Hospitalization Surveilance Network Case Report Form Modified 9770 3183 0 Form and Instruction none
Influenza Hospitalization Surveillance Project Provider Vaccination History Fax Form (Children/Adults) Unchanged 3330 278 0 Form and Instruction 0920-0978
Influenza Hospitalization Surveillance Project Vaccination Telephone Script / Consent Form (English) Unchanged 3330 278 0 Form and Instruction 0920-0978
Form and Instruction 0920-0978
Influenza Hospitalization Surveillance Project Vaccination Telephone Script / Consent Form (Spanish) Unchanged 3330 278 0 Form and Instruction 0920-0978
Form and Instruction 0920-0978
Total burden requested under this ICR: 100410 39300 0  
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