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View Information Collection (IC)
View Information Collection (IC)
IC Title:
[OADPS/NCEZID] HAI/IR Programs (2023-2025)
Agency IC Tracking Number:
0920-25-0105
IC Status:
Modified
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
0920-1282
Form 1 - HAI/AR Response & Prevention Performance Measures PM1 - PM5
[NCEZID] - Data Reporting [Form 1] [revision 2024-2026] [03-17-2025].pdf
NA
Yes
Yes
Fillable Fileable
Form
0920-1282
Form 2-1 - HAI/AR Performance Measures (SHARP Project III; Antibiotic Stewardship
[NCEZID] - Data Reporting [Form 2 - 1] [revision 2024-2026] [03-17-2025].pdf
NA
Yes
Yes
Fillable Fileable
Form
0920-1282
Form 3 - HAI/AR Performance Measures (SHARP Project IV; NHSN)
[NCEZID] - Data Reporting [Form 3] [new 2023-2025] [07-26-2023].pdf
NA
Yes
Yes
Fillable Fileable
Form
0920-1282
Form 4 - HAI/AR Performance Measures (SHARP Project V; Project Firstline)
[NCEZID] - Data Reporting [Form 4] [revision 2024-2026] [03-17-2025].pdf
NA
Yes
Yes
Fillable Fileable
Form
0920-1282
Form 5 - HAI/AR Program Staffing Directory
[NCEZID] - Data Reporting [Form 5] [new 2023-2025] [07-26-2023].pdf
NA
Yes
Yes
Fillable Fileable
Form and Instruction
n/a
Form 2-2 - HAI/AR Performance Measures (SHARP Project III; Antibiotic Stewardship
[NCEZID] - Data Reporting [Form 2 - 2] [revision 2024-2026] [03-17-2025].pdf
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
336
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
100 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
672
0
39
0
0
633
Annual IC Time Burden (Hours)
1,545
0
122
0
0
1,423
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
0920-1282 GenIC Request Template
[NCEZID] - GenIC Request [new 2023-2025] [07-26-2023].pdf
07/31/2023
Funding Awards by Recipient
[NCEZID] - Funding awards by recipient [new 2023-2025] [07-26-2023].docx
07/31/2023
REDCap Form - cover page
[NCEZID] - REDCap form cover page [new 2023-2025] [07-26-2023].docx
07/31/2023
Sample Email
[NCEZID] - Sample Email [new 2023-2025] [07-26-2023].docx
07/31/2023
Technical Specifications
[NCEZID] - Technical specifications [new 2023-2025] [07-26-2023].docx
07/31/2023
GenIC Request Template Updated
NCEZID - GenIC Request revision 2024-2026 03-17-2025_Updated_final.docx
06/17/2025
Change Request Justification
Change-Memo-03 17 2025.docx
06/17/2025
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.