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
ABCs H. Influenzae Neonatal Sepsis Expanded Surveillance Form Unchanged 60 10 0 Form and Instruction 0920-0978
ABCs Severe GAS Infection Supplemental Form Unchanged 1360 453 0 Form and Instruction 0920-0978
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) Neonatal Infection Expanded Tracking Form Unchanged 370 123 0 Form and Instruction 0920-0978
FluServ-NET Hospitalization Surveillance Project Vaccination PhoneScript / Consent Form (English/Spanish) Modified 224 37 0 Form and Instruction 0920-0978
FluSrv-NET Laboratory Survey (2023-24) Modified 240 40 0 Form CS 341327-A
FluSurv-NET Hospitalization Surveillance Project History Fax Form (Children/Adults) Modified 1764 147 0 Form and Instruction 0920-0978
FluSurv-Net Influenza Hospitalization Surveillance Network Case Report Form (CFR) Modified 10905 4544 0 Form and Instruction CS340190-A
Form 0920-0978
FoodNet Active Surveillance Data Element - [Cyclospora] Modified 420 70 0 Form 0920-0978
FoodNet Active Surveillance Data Element - [Listeria monocytogenes] Modified 160 53 0 Form 0920-0978
FoodNet Active Surveillance Data Element - [Salmonella] Modified 8550 2993 0 Form 0920-0978
FoodNet Active Surveillance Data Element - [Shiga toxin producing E. coli] Modified 2900 967 0 Form 0920-0978
FoodNet Active Surveillance Data Element - [Shigella] Modified 2340 390 0 Form 0920-0978
FoodNet Active Surveillance Data Element - [Vibrio] Modified 460 77 0 Form 0920-0978
FoodNet Active Surveillance Data Element - [Yersinia] Modified 550 92 0 Form 0920-0978
FoodNet Active Surveillance Data Element [Campylobacter] Modified 9700 3395 0 Form 0920-0978
FoodNet Hemolytic Uremic Syndrome (HUS) Unchanged 100 100 0 Form and Instruction 0920-0978
Foodnet Clinical Laboratory Practices and Testing Volume Modified 700 117 0 Form and Instruction 0920-0978
HAIC (MuGSI) Community-Associated CP-CRE Interview Modified 100 50 0 Form 0920-0978
HAIC (MuGSI) Supplemental Surveillance Officer Survey Modified 10 3 0 Form and Instruction C5342262-A
HAIC - CDI Annual Surveillance Officers Survey Modified 10 3 0 Form 0920-0978
HAIC -Labortary Testing Practices for Candidemia Questionnaire Modified 200 47 0 Form 0920-0978
HAIC CDI Annual Laboratory Survey Modified 160 45 0 Form 0920-0978
HAIC CDI Case Report Form Modified 16500 10450 0 Form and Instruction CS 342179-A
HAIC CDI LTCF Survey Unchanged 450 38 0 Form and Instruction 0920-0978
HAIC Candidemia Case Report Form Modified 1700 1133 0 Form Short Form 2024
HAIC Death Ascertainment Project Unchanged 80 1920 0 Form and Instruction 0920-0978
HAIC Invasive Methicillin-Sensitive Staphylococcus aureus (MSSA) Removed 0 0 0 Form and Instruction 0920-0978
HAIC Invasive Staphylococcus aureus Annual Laboratory Survey Modified 110 37 0 Form 0920-0978
HAIC Invasive Staphylococcus aureus Annual Surveillance Officers Survey Modified 10 2 0 Form and Instruction 0920-0978
HAIC Invasive Staphylococcus aureus Infection Case Report Form Modified 7800 3640 0 Form CDC 52.15B
HAIC Multi-Site Gram-Negative Surveillance Initiative - Extended Spectrum Beta-Lactamase Producing Enterobacteriaceae (MuGSI-ESBL) Removed 0 0 0 Form 0920-0978
HAIC- Multi-Site Gram-Negative Surveillance Initiative (MuGSI) Case Report Form (CFR) Modified 47000 21933 0 Form CS342262-A
Influenza Hospitalization Surveillance Project Vaccination Telephone Script / Consent Form (English) Removed 0 0 0 Form and Instruction 0920-0978
Total burden requested under this ICR: 124293 55818 0  
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