Information Collection Request

Emerging Infections Program

ICR 201705-0920-001 · OMB 0920-0978 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form 17AHK 2015 ABCs H. Influenzae Neonatal Sepsis Expanded Surveillance Form Form and Instruction Modified Available
Resistant Gram-Negative Bacilli Case Report Form Form Unchanged Available
CDI Treatment Form Form Unchanged Available
CDI Case Report Form Form Unchanged Repair queued
ABCs Non Bacteremic Pneumococcal Disease Form Unchanged Available
FluSurv-Net Project Consent Form Form Unchanged Repair queued
Influenza Hospitalization Surveillance Project Vaccination Telephone Survey Form Unchanged Repair queued
Hemolytic Uremic Syndrome (HUS) Form Unchanged Available
FluSurv-NET Influenza Hospitalization Surveilance Project Case Report Form Form Unchanged Repair queued
Legionellosis ABCs Case Report Form Removed Available
Form 17AHK ABCs Neonatal Infection Expanded Tracking Form Form and Instruction Modified Repair queued
Form 17AHK ABCs Invasive Pneumococcal Disease in Children Form and Instruction Modified Repair queued
Invasive Methicillin - Resistant - Staphylococcus aureus ABCs Case Report Form Form Unchanged Repair queued
Form 17AHK ABCs Case Report Form Form and Instruction Modified Repair queued
Final EIP Justification OMB 0920-0978 nonsubstantive ABCs only April262017 CLEAN.doc Justification for No Material/Nonsubstantive Change Uploaded 2017-05-03 Repair queued
EIP OMB 0920-0978 nonsub change request.doc Justification for No Material/Nonsubstantive Change Uploaded 2016-12-28 Available
Att. B - FoodNet Variable List_2016_SiteTransmitted.pdf Supplementary Document Uploaded 2016-12-28 Repair queued
EIP 2016 Change Request.docx Justification for No Material/Nonsubstantive Change Uploaded 2016-03-02 Available
Attachment_25_ CDI ASSENT for 13-15.pdf Supplementary Document Uploaded 2015-07-07 Repair queued
Attachment_24_ADULT VERBAL CONSENT Assent 16_17 for CDI.PDF Supplementary Document Uploaded 2015-07-07 Available
60 day published.pdf Supplementary Document Uploaded 2015-07-07 Available
Part B_EIP OMB 2015 Revision_SMN 23Feb2016.docx Supporting Statement B Uploaded 2016-02-24 Repair queued
Part A_EIP OMB 2015 Revision_SMN 23Feb2016.docx Supporting Statement A Uploaded 2016-02-24 Repair queued
EIP 2015 Change Request_justification_revised 2-17-15.docx Justification for No Material/Nonsubstantive Change Uploaded 2015-02-17 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
220380 2015 ABCs H. Influenzae Neonatal Sepsis Expanded Surveillance Form Form and Instruction Modified
217339 CDI Telephone Interview Other-Telephone Interview Unchanged
217338 CDI Screening Form Other-Interview Screen Unchanged
217336 Resistant Gram-Negative Bacilli Case Report Form Form Unchanged
217335 CDI Treatment Form Form Unchanged
217334 CDI Case Report Form Form Unchanged
215016 ABCs Non Bacteremic Pneumococcal Disease Form Unchanged
207663 Yersinia Other-WORD Unchanged
207662 Vibrio Other-WORD Unchanged
207661 Shigella Other-WORD Unchanged
207660 Shiga toxin producing E. coli Other-WORD Unchanged
207659 Salmonella Other-WORD Unchanged
207658 Listeria monocytogenes Other-WORD Unchanged
207657 Cyclospora Other-WORD Unchanged
207656 Cryptosporidium Other-WORD Unchanged
207655 Campylobacter Other-WORD Unchanged
207654 FluSurv-Net Project Consent Form Form Unchanged
207653 Influenza Hospitalization Surveillance Project Vaccination Telephone Survey Form Unchanged
207652 Hemolytic Uremic Syndrome (HUS) Form Unchanged
207651 FluSurv-NET Influenza Hospitalization Surveilance Project Case Report Form Form Unchanged
207650 Legionellosis ABCs Case Report Form Removed
207649 ABCs Neonatal Infection Expanded Tracking Form Form and Instruction Modified
207648 ABCs Invasive Pneumococcal Disease in Children Form and Instruction Modified
207647 Invasive Methicillin - Resistant - Staphylococcus aureus ABCs Case Report Form Form Unchanged
207646 ABCs Case Report Form Form and Instruction Modified
ICR Details
0920-0978 201705-0920-001
Historical Active 201612-0920-015
HHS/CDC 17AHK
Emerging Infections Program
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 05/05/2017
Retrieve Notice of Action (NOA) 05/04/2017
Previous terms continue: Approved consistent with the understanding that this consolidation will result in the modification and/or discontinuation of related CDC ICRs.
  Inventory as of this Action Requested Previously Approved
02/28/2019 02/28/2019 02/28/2019
80,420 0 81,420
22,473 0 22,806
0 0 0

This non-substantive change request is for changes to the disease-specific data elements for ABCs only. As a result of proposed changes, the estimated annualized burden is expected to decrease by 333 hours, from 22,806 to 22,473, The data elements and justifications are described below. The forms for which approval for changes and additions are being sought include: 1. 2017 ABCs Case Report Form (Att. 1) 2. 2017 ABCs H. influenzae Neonatal Sepsis Expanded Surveillance Form (Att. 2) 3. 2017 Neonatal Infection Expanded Case Report Form (Att. 3) 4. 2017 ABCs Invasive Pneumococcal Disease in Children (SPN Expanded CRF) (Att. 4) 5. Legionellosis Expanded Case Report Form (discontinued)

US Code: 42 USC 301 Name of Law: Public Health Service Act
  
None

Not associated with rulemaking

  80 FR 26051 05/06/2015
80 FR 39780 07/10/2015
No

24
IC Title Form No. Form Name
Shigella
Vibrio
Yersinia
Resistant Gram-Negative Bacilli Case Report Form VERSION: 11/2017, VERSION:01-2016, NA 2015 Multi-site Gram-Negative Surveillance Initiative (MuGSI) Healthcare Associated Infection Community Interface (HAIC) Case Report ,   2016 Multi-site Gram Negative Surveillance Initiative (MuGSI) Healthcare Associated Infection Community Interface (HAIC) Case Report ,   2017 Multi-site Gram-Negative Surveillance Initiative (MuGSI) HAIC Case Report
CDI Case Report Form CDC Rev 09-2016, CDC Rev.10-2015, NA Clostridium Difficile Infection (CDI) Surveillance Emerging Infections Program Case Report ,   Clostridium Difficile Infection (CDI) Surveillance Emerging Infections Program Case Report ,   CLOSTRIDIUM DIFFICILE INFECTION (CDI) SURVEILLANCE EMERGING INFECTIONS PROGRAM CASE REPORT
Invasive Methicillin - Resistant - Staphylococcus aureus ABCs Case Report Form CDC 52.15B Rev 09-2016, none, CDC 52.15B Rev 10-2015 Invasive Methicillin-Resistant Staph ,   Healthcare-Associated Infections Community Interface (HACI) Case Report -2016 ,   Invasive Methicillin-Resistant Staphylococcus aureus HAIC Case Report - 2017
CDI Treatment Form NA EIP CDI Surveillance: CDI Case Treatment Questionnaire
Shiga toxin producing E. coli
CDI Telephone Interview
CDI Screening Form
2015 ABCs H. Influenzae Neonatal Sepsis Expanded Surveillance Form 17AHK Att. 2 - ABCs H. Influenzae Neonatal Sepsis Expanded Surveillance Form_HiNSES
ABCs Case Report Form 17AHK Att. 1 - 2017 ACTIVE BACTERIAL CORE SURVEILLANCE CASE REPORT
ABCs Non Bacteremic Pneumococcal Disease CDC, none Non Bacteremic Pneumococcal 2015 ,   2016 Surveillance for Non-Invasive Penumococcal Pneumonia (SNiPP)
Influenza Hospitalization Surveillance Project Vaccination Telephone Survey none Vaccination Telephone Survey - English
FluSurv-Net Project Consent Form none Consent
Campylobacter
Cryptosporidium
Cyclospora
Listeria monocytogenes
Salmonella
Legionellosis ABCs Case Report none Legionellosis Case Report
ABCs Invasive Pneumococcal Disease in Children 17AHK Att. 4 - ACTIVE BACTERIAL CORE SURVEILLANCE (ABCs) INVASIVE PNEUMOCOCCAL DISEASE IN CHILDREN
ABCs Neonatal Infection Expanded Tracking Form 17AHK Att. 3 - ACTIVE BACTERIAL CORE SURVEILLANCE (ABCs) Neonatal Infection Expanded Tracking Form
FluSurv-NET Influenza Hospitalization Surveilance Project Case Report Form CDC Rev 07-2015, none FluSurv-NET Influenza Hospital Surveillance Project ,   2015-16 FluSurv-NET Influenza Hospitalization Surveillance Project Case Report Form
Hemolytic Uremic Syndrome (HUS) NA FoodNet Hemolytic Uremic Syndrome (HUS) Surveillance

  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 80,420 81,420 0 -1,000 0 0
Annual Time Burden (Hours) 22,473 22,806 0 -333 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes
Miscellaneous Actions
The changes made to the ABCs forms under this non-substantive request will aid in clarifying the burden of disease and possible risk factors for disease. This information can be used to inform strategies for preventing disease and negative outcomes.

$20,221,865
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Catina Conner 404 639-4775

  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.
05/04/2017