OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Post-Discharge Hospital Patients without MRSA infection (Control Patients) Telephone Interview

IC 205891 under ICR 201302-0920-016 · OMB 0920-0958.

Documents and Forms
Document Name
Document Type
Instruction
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Post-Discharge Hospital Patients without MRSA infection (Control Patients) Telephone Interview
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction Attachment G - Telephone Interview Revised_4_01.04.2013_clean.docx Yes Yes Printable Only

Health Immunization Management

 

190 0
   
Individuals or Households
 
   0 %

  Approved 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 190 0 190 0 0 0
Annual IC Time Burden (Hours) 63 0 63 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment C. ABCs MRSA. CRF Attachment C. ABCs MRSA. CRF.pdf 02/15/2013
Attachment D. MR review form for Case and Control Attachment D. MR review form for Case and Control.pdf 02/15/2013
Attachment H_ Nursing Home Medical Record review Form Attachment H_ Nursing Home Medical Record review Form.pdf 02/15/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.