Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
(MuGSI) Healthcare-Associated Infections Community Interface (HAIC) Case Report Modified 17391 8406 0 Form and Instruction HAIC.400.1
ABCs Invasive Pneumococcal Disease in Children and Adults Unchanged 1270 212 0 Form and Instruction ABC 100.2
Active Bacterial Core Surveillance (ABCs) Case Report Modified 9840 3280 0 Form and Instruction ABC.100.1
Active Bacterial Core Surveillance (ABCs) Neonatal Infection Expanded Tracking Form Modified 370 123 0 Form and Instruction ABC 100.5
Annual Survey of Laboratory Testing Practices for C. difficile Infection Modified 200 57 0 Form and Instruction HAIC.400.8
CANDIDEMIA CASE REPORT FORM Unchanged 1700 1133 0 Form and Instruction HAIC.400.11
CDC's Healthcare-Associated Infections Community Interface (HAIC) Staphylococcus aureus Laboratory Survey Modified 110 17 0 Form and Instruction HAIC.400.5
CLOSTRIDIOIDES DIFFICILE INFECTION (CDI) SURVEILLANCE EMERGING INFECTIONS PROGRAM CASE REPORT Modified 14300 9057 0 Form and Instruction HAIC.400.7
Community-Associated CP-CRE Interview Unchanged 100 50 0 Form and Instruction HAIC.400.2
Data Elements Transferred to CDC for the HAIC Death Ascertainment Project Unchanged 80 1920 0 Form and Instruction HAIC.400.13
Emerging Infections Program C. difficile Surveillance Nursing Home Telephone Survey Unchanged 450 38 0 Form and Instruction HAIC.400.10
FLUSURV-NET: CONSENT FORM FOR PATIENT/PROXY INTERVIEW (English/Spanish) Modified 264 44 0 Form and Instruction FSN.300.2
FLUSURV-NET: PROVIDER PEDIATRIC VACCINATION HISTORY REQUEST LETTER/FORM Modified 768 64 0 Form and Instruction FSN.300.3
FluSurv-NET Laboratory Survey Modified 252 34 0 Form FSN.300.4
FluSurv-Net Influenza Hospitalization Surveillance Network Case Report Form Modified 7840 3267 0 Form and Instruction FSN.300.1
FoodNET Lab Survey Variable List Unchanged 700 117 0 Form FN.200.10
FoodNet Hemolytic Uremic Syndrome (HUS) Unchanged 100 100 0 Form and Instruction FN.200.9
FoodNet Variable List_ (CYCLOSPORA) Unchanged 420 70 0 Form and Instruction FN.200.2
FoodNet Variable List_ (LISTERIA MONOCTOGENES) Unchanged 160 53 0 Form and Instruction FN.200.3
FoodNet Variable List_ (SALMONELLA) Unchanged 8550 2993 0 Form and Instruction FN.200.4
FoodNet Variable List_ (SHIGA TOXIN PRODUCING E.COLI) Unchanged 2900 967 0 Form and Instruction FN.200.5
FoodNet Variable List_ (SHIGELLA) Unchanged 2340 390 0 Form and Instruction FN.200.6
FoodNet Variable List_ (VIBRIO) Unchanged 460 77 0 Form and Instruction FN.200.7
FoodNet Variable List_ (YERSINIA) Unchanged 550 92 0 Form and Instruction FN.200.8
FoodNet Variable List_(CAMPYLOBACTER) Unchanged 5500 1925 0 Form and Instruction FN.200.1
HAIC Invasive Staphylococcus aureus Supplemental Surveillance Officer Survey Unchanged 10 2 0 Form and Instruction HAIC.400.6
HAIC MuGSI KPC and NDM Treatment Collection Form Unchanged 600 600 0 Form and Instruction HAIC.400.14
HAIC Multi-site Gram-negative Surveillance Initiative (MuGSI) Supplemental Surveillance Officer Survey Modified 11 4 0 Form and Instruction HAIC.400.3
HAIC-Surveillance Officer's Survey Modified 10 3 0 Form and Instruction HAIC.400.9
HAIC_LABORATORY TESTING PRACTICES FOR CANDIDEMIA QUESTIONNAIRE Unchanged 200 47 0 Form and Instruction HAIC.400.12
Invasive Staphylococcus aureus Healthcare-Associated Infections Community Interface (HAIC) Case Report Modified 6700 3127 0 Form and Instruction HAIC.400.4
Total burden requested under this ICR: 84146 38269 0  
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