Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
2024 Active Bacterial Core Surveillance (ABCs) Case Report Modified 8090 2697 0 Form and Instruction CDC 52.12A 2024 Active Bacterial Core Surveillance (ABCs) 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 Severe GAS Infection Supplemental Form Unchanged 1360 453 0 Form and Instruction 0920-0978 ABC Severe GAS Infection Supplemental Form
Active Bacterial Core Surveillance (ABCs) Invasive Pneumococcal Disease in Children (aged ≥2 months to <5 years) and Adults (aged ≥65 years) Modified 1270 212 0 Form and Instruction CDC 52.15A ACTIVE BACTERIAL CORE SURVEILLANCE (ABCs) INVASIVE PNEUMOCOCCAL DISEASE IN CHILDREN (aged ≥2 months to <5 years) AND ADULTS (aged ≥65 years)
Active Bacterial Core Surveillance (ABCs) Neonatal Infection Expanded Tracking Form Unchanged 370 123 0 Form and Instruction 0920-0978 Active Bacterial Core Surveillance (ABCs) Neonatal Infection Expanded Tracking Form
FluServ-NET Hospitalization Surveillance Project Vaccination PhoneScript / Consent Form (English/Spanish) Modified 224 37 0 Form and Instruction 0920-0978 APPENDIX 5B. CONTACTING PATIENTS, PROXIES OR PARENTS/GUARDIANS FOR VACCINATION STATUS
FluSrv-NET Laboratory Survey (2023-24) Modified 240 40 0 Form CS 341327-A FluSurv-NET Laboratory Survey 2023–2024 Season
FluSurv-NET Hospitalization Surveillance Project History Fax Form (Children/Adults) Modified 1764 147 0 Form and Instruction 0920-0978 APPENDIX 5A.2: PROVIDER ADULT VACCINATION HISTORY REQUEST LETTER/FORM
FluSurv-Net Influenza Hospitalization Surveillance Network Case Report Form (CFR) Modified 10905 4544 0 Form and Instruction CS340190-A 2022-23 FluSurv-NET Influenza Hospitalization Surveillance Project Case Report Form
Form 0920-0978 Data Collection Elements for COVID-19 Vaccination Status on 2023-24 FluSurv-NET Cases
FoodNet Active Surveillance Data Element - [Cyclospora] Modified 420 70 0 Form 0920-0978 FoodNet Variable List, 2024
FoodNet Active Surveillance Data Element - [Listeria monocytogenes] Modified 160 53 0 Form 0920-0978 FoodNet Variable List, 2024
FoodNet Active Surveillance Data Element - [Salmonella] Modified 8550 2993 0 Form 0920-0978 FoodNet Variable List, 2024
FoodNet Active Surveillance Data Element - [Shiga toxin producing E. coli] Modified 2900 967 0 Form 0920-0978 FoodNet Variable List, 2024
FoodNet Active Surveillance Data Element - [Shigella] Modified 2340 390 0 Form 0920-0978 FoodNet Variable List, 2024
FoodNet Active Surveillance Data Element - [Vibrio] Modified 460 77 0 Form 0920-0978 FoodNet Variable List, 2024
FoodNet Active Surveillance Data Element - [Yersinia] Modified 550 92 0 Form 0920-0978 FoodNet Variable List, 2024
FoodNet Active Surveillance Data Element [Campylobacter] Modified 9700 3395 0 Form 0920-0978 FoodNet Variable List, 2024
FoodNet Hemolytic Uremic Syndrome (HUS) Unchanged 100 100 0 Form and Instruction 0920-0978 FoodNet CDC's FoodNet Hemolytic Uremic syndrome (HUS) Surveillance Case Report Form
Foodnet Clinical Laboratory Practices and Testing Volume Modified 700 117 0 Form and Instruction 0920-0978 FoodNET Clinical Lab Practices and Testing Volume
HAIC (MuGSI) Community-Associated CP-CRE Interview Modified 100 50 0 Form 0920-0978 CA CP-CRE Survey Questionnaire
HAIC (MuGSI) Supplemental Surveillance Officer Survey Modified 10 3 0 Form and Instruction C5342262-A 2024 Multi-site Gram-Negative Surveillance Initiative (MuGSI) Healthcare-Associated Infections Community Interface (HAIC) Case Report
HAIC - CDI Annual Surveillance Officers Survey Modified 10 3 0 Form 0920-0978 Surveillance Officer's Survey- Clostridioides difficile Infection (CDI) Surveillance
HAIC -Labortary Testing Practices for Candidemia Questionnaire Modified 200 47 0 Form 0920-0978 2024 LABORATORY TESTING PRACTICES FOR CANDIDEMIA QUESTIONNAIRE
HAIC CDI Annual Laboratory Survey Modified 160 45 0 Form 0920-0978 Annual Survey of Laboratory Testing Practices for C. difficile Infection
HAIC CDI Case Report Form Modified 16500 10450 0 Form and Instruction CS 342179-A 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 Modified 1700 1133 0 Form Short Form 2024 CANDIDEMIA 2024 CASE REPORT FORM
HAIC Death Ascertainment Project Unchanged 80 1920 0 Form and Instruction 0920-0978 Death Ascertainment Project Variables
HAIC Invasive Methicillin-Sensitive Staphylococcus aureus (MSSA) Removed 0 0 0 Form and Instruction 0920-0978 Invasive Methicillin-Resistant Staphylococcus aureus Healthcare-Associated Infections Community Interface (HAIC) Case Report – 2023
HAIC Invasive Staphylococcus aureus Annual Laboratory Survey Modified 110 37 0 Form 0920-0978 CDC’s Healthcare-Associated Infections Community Interface (HAIC) Staphylococcus aureus 2024 Laboratory Survey
HAIC Invasive Staphylococcus aureus Annual Surveillance Officers Survey Modified 10 2 0 Form and Instruction 0920-0978 2023 HAIC Invasive Staphylococcus aureus Supplemental Surveillance Officer Survey
HAIC Invasive Staphylococcus aureus Infection Case Report Form Modified 7800 3640 0 Form CDC 52.15B Invasive Staphylococcus aureus Healthcare-Associated Infections Community Interface (HAIC) Case Report – 2024
HAIC Multi-Site Gram-Negative Surveillance Initiative - Extended Spectrum Beta-Lactamase Producing Enterobacteriaceae (MuGSI-ESBL) Removed 0 0 0 Form 0920-0978 2023 MuGSI Extended-Spectrum Beta-Lactamase (ESBL)-Producing Enterobacteriaceae/Omvasove Escjerocjoa coli (MuGSI) (HAIC) Case Report
HAIC- Multi-Site Gram-Negative Surveillance Initiative (MuGSI) Case Report Form (CFR) Modified 47000 21933 0 Form CS342262-A 2024 Multi-site Gram-Negative Surveillance Initiative (MuGSI) Healthcare-Associated Infections Community Interface (HAIC) Case Report
Influenza Hospitalization Surveillance Project Vaccination Telephone Script / Consent Form (English) Removed 0 0 0 Form and Instruction 0920-0978 FluSurv NET Vaccination Phone Script
Total burden requested under this ICR: 124293 55818 0  
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