OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Risk Factors for Invasive Methicillin-Resistant Staphylococcus aureus (MRSA) among Patients Recently Discharged from Acute Care Hospitals

ICR 201302-0920-016 · OMB 0920-0958 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Revised_ Supporting Statement Part B HACO_revised_02.05.2013.docx Supporting Statement B Uploaded 2013-02-13 Available
Attachment J-HACO IRB approval letter.docx Supplementary Document Uploaded 2013-02-13 Repair queued
Attachment I_non research determination.pdf Supplementary Document Uploaded 2013-02-13 Available
Attachment A Sec. 301 42 USC 241[1].pdf Supplementary Document Uploaded 2013-02-13 Available
Attachment H_ Nursing Home Medical Record review Form.pdf Supplementary Document Uploaded 2013-02-15 Available
Attachment D. MR review form for Case and Control.pdf Supplementary Document Uploaded 2013-02-15 Available
Attachment C. ABCs MRSA. CRF.pdf Supplementary Document Uploaded 2013-02-15 Available
Attachment E - Verbal Consent.revised docx.docx Supplementary Document Uploaded 2013-02-14 Available
Revised_ Supporting Statement Part A HACO_02.05.2013.docx Supporting Statement A Uploaded 2013-02-13 Available
IC Document Collections
IC IDCollectionTypeStatusForm
205891 Post-Discharge Hospital Patients without MRSA infection (Control Patients) Telephone Interview Instruction New
205890 Post-discharge Hospital Patients without MRSA Infection (Control-Patients) Screening and Consent Instruction New
205889 Post-Discharge Hospital Patients (Case Patients)- Telephone Interview Instruction New
205888 Post-discharge Hospital Patients with MRSA (Case Patients) - Screening and Consent Process Instruction New
ICR Details
0920-0958 201302-0920-016
Historical Active
HHS/CDC 18811
Risk Factors for Invasive Methicillin-Resistant Staphylococcus aureus (MRSA) among Patients Recently Discharged from Acute Care Hospitals
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 03/20/2013
Retrieve Notice of Action (NOA) 02/21/2013
  Inventory as of this Action Requested Previously Approved
03/31/2015 24 Months From Approved
735 0 0
133 0 0
0 0 0
MRSA infections are associated with increased medical costs, morbidity and mortality. MRSA is resistan to first line antimicrobial therapies. Little is known about MRSA risk factors post-discharge.
US Code: 42 USC 301 Name of Law: USC 241
  
None
Not associated with rulemaking
  77 FR 24209 04/23/2012
77 FR 40363 07/09/2012
No
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 735 0 0 735 0 0
Annual Time Burden (Hours) 133 0 0 133 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new ICR request
$270,033
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Catina Conner 4046394775
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
02/21/2013