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 2022 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 none 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
Flu Surv NET Laboratory Survey Unchanged 160 26 0 Form none FluSurv Lab Survey
FoodNet Campylobacter Unchanged 9700 3395 0 Other-Variable list
FoodNet Cyclospora Unchanged 420 70 0 Other-Variable list
FoodNet Hemolytic Uremic Syndrome (HUS) Unchanged 100 100 0 Form and Instruction 0920-0978 FoodNet HUS CRF
FoodNet Listeria monocytogenes Unchanged 160 53 0 Other-Variable list
FoodNet Salmonella Unchanged 8550 2993 0 Other-Variable list
FoodNet Shiga toxin producing E. coli Unchanged 2900 967 0 Other-Variable list
FoodNet Shigella Unchanged 2340 390 0 Other-Variable list
FoodNet Vibrio Unchanged 460 77 0 Other-Variable list
FoodNet Yersinia Unchanged 550 92 0 Form and Instruction 0920-0978 Foodborne and DIarrheal Diseases Message Mapping Guide (FDD MMG - FoodNet only portion)
Other-Variable list
Foodnet Clinical Laboratory Practices and Testing Volume Unchanged 700 233 0 Form and Instruction none FoodNET Lab Practices Volume
HAIC CDI Annual Laboratory Survey Unchanged 160 51 0 Form and Instruction n/a 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 Unchanged 16500 10450 0 Form and Instruction none CDI 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 1700 1134 0 Form and Instruction none Candidemia Case Report
HAIC Candidemia Periodic Laboratory Survey Unchanged 200 40 0 Form and Instruction none Candidemia Lab Survey
HAIC Invasive Methicillin-Sensitive Staphylococcus aureus (MSSA) Modified 4750 2217 0 Form and Instruction none MSSA Report 2021
HAIC Invasive Methicillin-resistant Staphylococcus aureus (MRSA) Modified 3440 1605 0 Form and Instruction none Invasive MRSA Case Report
HAIC Invasive Staphylococcus aureus Annual Laboratory Survey Unchanged 110 37 0 Form and Instruction none Invasive Staph aureus Lab Survey
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 n/a 2021 Carbapenem Resistant Enterobacteriaceae (CRE)/ Carbapenem resistant A. baumannii (CRAB) MuGSI HAIC Case Report Form
Form 0920-0978 2022 Carbapenem Resistant Enterobacteriaceae (CRE)/ Carbapenem resistant A. baumannii (CRAB) MuGSI HAIC Case Report Form
HAIC Multi-Site Gram-Negative Surveillance Initiative - Extended Spectrum Beta-Lactamase Producing Enterobacteriaceae (MuGSI-ESBL) Modified 11040 5152 0 Form and Instruction n/a 2021 MuGSI Extended-Spectrum Beta-Lactamase (ESBL)-Producing Enterobacteriaceae Case Report Form
Form 0920-0978 2022 MuGSI Extended-Spectrum Beta-Lactamase (ESBL)-Producing Enterobacteriaceae Case Report Form
Influenza Hospitalization Surveilance Network Case Report Form Unchanged 9770 3183 0 Form and Instruction none Influenza Hospitalization Surveillance Network Case Report
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: 99360 38810 0  
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