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 1270 212 0 Form and Instruction 0920-0978
ABCs Neonatal Infection Expanded Tracking Form Modified 370 123 0 Form and Instruction none
ABCs Severe GAS Infection Supplemental Form Modified 1360 453 0 Form and Instruction 0920-0978
Community-Associated CP-CRE Interview New 100 50 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 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 Modified 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 43 0 Form and Instruction none
HAIC Death Ascertainment Project New 80 1920 0 Form and Instruction 0920-0978
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 Modified 110 37 0 Form and Instruction none
HAIC Invasive Staphylococcus aureus Annual Surveillance Officers Survey Modified 10 2 0 Form and Instruction 0920-0978
HAIC Multi-Site Gram-Negative Bacilli Case Report Form (MuGSI-CRE/CRAB) Modified 5000 2333 0 Form 0920-0978
HAIC Multi-Site Gram-Negative Surveillance Initiative - Extended Spectrum Beta-Lactamase Producing Enterobacteriaceae (MuGSI-ESBL) Modified 42000 17500 0 Form 0920-0978
HAIC Multi-site Gram-negative Surveillance Initiative (MuGSI) Supplemental Surveillance Officer Survey New 10 3 0 Form and Instruction 0920-0978
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) 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
Influenza Hospitalization Surveillance Project Vaccination Telephone Script / Consent Form (Spanish) Modified 3330 278 0 Form and Instruction 0920-0978
Total burden requested under this ICR: 132520 53784 0  
To view an IC, click on IC Title