Information Collection Request

Emerging Infections Program

ICR 201805-0920-010 · OMB 0920-0978 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form 0920-0978 HAIC Candidemia Case Report Form Form and Instruction Unchanged Available
Form 0920-0978 HAIC Invasive Methicillin-Sensitive Staphylococcus aureus (MSSA) Form and Instruction Unchanged Available
Form 0920-0978 HAIC Multi-Site Gram-Negative Surveillance Initiative - Extended Spectrum Beta-Lactamase Producing Enterobacteriaceae (MuGSI-ESBL) Form and Instruction Unchanged Repair queued
Form 0920-0978 Influenza Hospitalization Surveillance Project Provider Vaccination History Fax Form (Children/Adults) Form and Instruction Unchanged Repair queued
Form 0920-0978 Influenza Hospitalization Surveillance Project Vaccination Telephone Script / Consent Form (Spanish) Form and Instruction Unchanged Available
Form 0920-0978 HAIC Multi-Site Gram-Negative Bacilli Case Report Form for Carbapenem-Resistant Pseudomonas ajeruginosa (CR-PA) Form Unchanged Repair queued
Form 0920-0978 ABCs Severe GAS Infection Supplemental Form Form Unchanged Available
Form 17AHK ABCs H. Influenzae Neonatal Sepsis Expanded Surveillance Form Form and Instruction Unchanged Repair queued
HAIC Multi-Site Gram-Negative Bacilli Case Report Form (MuGSI-CRE/CRAB) Form Unchanged Repair queued
Form 0920-0978 HAIC CDI Case Report Form Form Modified Repair queued
ABCs Surveillance for Non-Invasive Pneumococcal Pneumonia (SNiPP) Case Report Form Form Unchanged Available
Form 0920-0978 FoodNet Yersinia Form Unchanged Repair queued
Form 0920-0978 FoodNet Vibrio Form Unchanged Repair queued
Form 0920-0978 FoodNet Shigella Form Unchanged Repair queued
Form 0920-0978 FoodNet Shiga toxin producing E. coli Form Unchanged Repair queued
Form 0920-0978 FoodNet Salmonella Form Unchanged Repair queued
Form 0920-0978 FoodNet Listeria monocytogenes Form Unchanged Repair queued
Form 0920-0978 FoodNet Cyclospora Form Unchanged Repair queued
Form 0920-0978 FoodNet Cryptosporidium Form Unchanged Repair queued
Form 0920-0978 FoodNet Campylobacter Form Unchanged Repair queued
Form 0920-0978 Influenza Hospitalization Surveillance Project Vaccination Telephone Script / Consent Form (English) Form and Instruction Unchanged Repair queued
FoodNet Hemolytic Uremic Syndrome (HUS) Form Unchanged Repair queued
Form 0920-0978 Influenza Hospitalization Surveilance Network Case Report Form Form Unchanged Repair queued
Form 17AHK ABCs Neonatal Infection Expanded Tracking Form Form and Instruction Unchanged Repair queued
Form 17AHK ABCs Invasive Pneumococcal Disease in Children Form and Instruction Unchanged Repair queued
Form 0920-0978 HAIC Invasive Methicillin-resistant Staphylococcus aureus (MRSA) Form Unchanged Repair queued
Form 17AHK ABCs Case Report Form Form and Instruction Unchanged Available
CDI_Non-sub change request_FINAL_20180524.doc Justification for No Material/Nonsubstantive Change Uploaded 2018-05-31 Repair queued
02- 60-Day FRN.PDF Supplementary Document Uploaded 2018-04-18 Available
Part B_EIP OMB Revision 20MAR2018.docx Supporting Statement B Uploaded 2018-03-29 Available
Part A_EIP OMB 2018 Revision_FINAL 28MAR2018.docx Supporting Statement A Uploaded 2018-03-29 Available
Non-sub change request_FINAL_20180118.doc Justification for No Material/Nonsubstantive Change Uploaded 2018-01-23 Available
Final EIP Justification OMB 0920-0978 nonsubstantive ABCs only April262017 CLEAN.doc Justification for No Material/Nonsubstantive Change Uploaded 2017-05-03 Available
EIP OMB 0920-0978 nonsub change request.doc Justification for No Material/Nonsubstantive Change Uploaded 2016-12-28 Repair queued
Att. B - FoodNet Variable List_2016_SiteTransmitted.pdf Supplementary Document Uploaded 2016-12-28 Available
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 Available
Attachment_24_ADULT VERBAL CONSENT Assent 16_17 for CDI.PDF Supplementary Document Uploaded 2015-07-07 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
231114 HAIC Candidemia Case Report Form Form and Instruction Unchanged
231113 HAIC Invasive Methicillin-Sensitive Staphylococcus aureus (MSSA) Form and Instruction Unchanged
231112 HAIC Multi-Site Gram-Negative Surveillance Initiative - Extended Spectrum Beta-Lactamase Producing Enterobacteriaceae (MuGSI-ESBL) Form and Instruction Unchanged
231111 Influenza Hospitalization Surveillance Project Provider Vaccination History Fax Form (Children/Adults) Form and Instruction Unchanged
231110 Influenza Hospitalization Surveillance Project Vaccination Telephone Script / Consent Form (Spanish) Form and Instruction Unchanged
230870 HAIC Multi-Site Gram-Negative Bacilli Case Report Form for Carbapenem-Resistant Pseudomonas ajeruginosa (CR-PA) Form Unchanged
230869 ABCs Severe GAS Infection Supplemental Form Form Unchanged
220380 ABCs H. Influenzae Neonatal Sepsis Expanded Surveillance Form Form and Instruction Unchanged
217336 HAIC Multi-Site Gram-Negative Bacilli Case Report Form (MuGSI-CRE/CRAB) Form Unchanged
217334 HAIC CDI Case Report Form Form Modified
215016 ABCs Surveillance for Non-Invasive Pneumococcal Pneumonia (SNiPP) Case Report Form Form Unchanged
207663 FoodNet Yersinia Form Unchanged
207662 FoodNet Vibrio Form Unchanged
207661 FoodNet Shigella Form Unchanged
207660 FoodNet Shiga toxin producing E. coli Form Unchanged
207659 FoodNet Salmonella Form Unchanged
207658 FoodNet Listeria monocytogenes Form Unchanged
207657 FoodNet Cyclospora Form Unchanged
207656 FoodNet Cryptosporidium Form Unchanged
207655 FoodNet Campylobacter Form Unchanged
207653 Influenza Hospitalization Surveillance Project Vaccination Telephone Script / Consent Form (English) Form and Instruction Unchanged
207652 FoodNet Hemolytic Uremic Syndrome (HUS) Form Unchanged
207651 Influenza Hospitalization Surveilance Network Case Report Form Form Unchanged
207649 ABCs Neonatal Infection Expanded Tracking Form Form and Instruction Unchanged
207648 ABCs Invasive Pneumococcal Disease in Children Form and Instruction Unchanged
207647 HAIC Invasive Methicillin-resistant Staphylococcus aureus (MRSA) Form Unchanged
207646 ABCs Case Report Form Form and Instruction Unchanged
ICR Details
0920-0978 201805-0920-010
Historical Active 201803-0920-010
HHS/CDC 0920-0978-18AKP
Emerging Infections Program
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 06/05/2018
Retrieve Notice of Action (NOA) 06/05/2018
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
05/31/2021 05/31/2021 05/31/2021
115,600 0 115,600
40,349 0 40,349
0 0 0

The Emerging Infections Programs (EIP) is to 1) detect and monitor emerging pathogens, the diseases they cause, and the factors influencing their emergence, and respond to problems as they are identified, 2) integrate laboratory science and epidemiology to optimize public health practice, 3) strengthen infrastructure to support surveillance and research and to implement prevention and control programs, and to 4) ensure implementation of prevention strategies and communication of public health information about emerging diseases. Surveillance efforts of the core EIP activities generate reliable estimates of the incidence of certain infections and provide the foundation for a variety of epidemiologic studies. This non-substantive change request is for a change to the disease-specific data elements for HAIC only. The form for which approval for change is sought is the 2018 Clostridium difficile Infection (CDI) Case Report Form. Description of Changes • Question 11c: the data field for “Facility ID” would be added • Question 14: The option to answer “Unknown” would be added” The changes made to the HAIC CDI form under this non-substantive request will aid in improving surveillance efficiency and data quality to clarify the burden of disease and possible risk factors for disease. As a result of proposed minor change, the estimated annualized burden is expected not to change.

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

Not associated with rulemaking

  82 FR 60608 12/21/2017
83 FR 17412 04/19/2018
No

27
IC Title Form No. Form Name
HAIC CDI Case Report Form 0920-0978 Clostridium Difficile Infection (CDI) Surveillance Emerging Infections Program Case Report
FoodNet Shiga toxin producing E. coli 0920-0978 FoodNet Variable List (site transmitted variables)
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 Surveillance for Non-Invasive Pneumococcal Pneumonia (SNiPP) Case Report Form none, CDC Non Bacteremic Pneumococcal 2015 ,   2016 Surveillance for Non-Invasive Penumococcal Pneumonia (SNiPP)
HAIC Invasive Methicillin-resistant Staphylococcus aureus (MRSA) 0920-0978 Invasive Methicillin-Resistant Staphylococcus aureaus Healthcare-Associated Infections Community Interface(HAIC) Case Report - 2018
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
Influenza Hospitalization Surveilance Network Case Report Form 0920-0978 2017-18 FluSurv-NET Influenza Hospitalization Surveillance Project Case Report Form
FoodNet Hemolytic Uremic Syndrome (HUS) NA FoodNet Hemolytic Uremic Syndrome (HUS) Surveillance
Influenza Hospitalization Surveillance Project Vaccination Telephone Script / Consent Form (English) 0920-0978, 0920-0978 FluServ-NET Consent Form - English ,   FluSurv-NET Vaccination Phone Script (English/Spanish)
FoodNet Campylobacter 0920-0978 FoodNet Variable List (site transmitted variables)
FoodNet Cryptosporidium 0920-0978 FoodNet Variable List (site transmitted variables)
FoodNet Cyclospora 0920-0978 FoodNet Variable List (site transmitted variables)
FoodNet Listeria monocytogenes 0920-0978 FoodNet Variable List (site transmitted variables)
FoodNet Salmonella 0920-0978 FoodNet Variable List (site transmitted variables)
FoodNet Shigella 0920-0978 FoodNet Variable List (site transmitted variables)
FoodNet Vibrio 0920-0978 FoodNet Variable List (site transmitted variables)
FoodNet Yersinia 0920-0978 FoodNet Variable List (site transmitted variables)
HAIC Multi-Site Gram-Negative Bacilli Case Report Form (MuGSI-CRE/CRAB) VERSION:01-2016, NA, 0920-09078, VERSION: 11/2017 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 ,   2018 Multi-Site Gram-Negative Surveillance Initiative (MuGSI) Healthcare Associated Infection Community Interface (HAIC) Case Report
ABCs Severe GAS Infection Supplemental Form 0920-0978 ABCs - Severe GAS Infection: Supplemental Form
HAIC Multi-Site Gram-Negative Bacilli Case Report Form for Carbapenem-Resistant Pseudomonas ajeruginosa (CR-PA) 0920-0978 Carbapenem-resistant Pseudomonas aeruginosa Multi-Site Gram-Negative Surveillance (MuGSI) Case Report
HAIC Multi-Site Gram-Negative Surveillance Initiative - Extended Spectrum Beta-Lactamase Producing Enterobacteriaceae (MuGSI-ESBL) 0920-0978 Surveillance for Extended-Spectrum Beta- Lactamase-Producing Enterobacteriaceae Multi-Site Gram-Negative Bacilli Surveillance (MuGSI) Healthcare Associated Infection Community Interface (HAIC) CRF
HAIC Invasive Methicillin-Sensitive Staphylococcus aureus (MSSA) 0920-0978 Invasive Methicillin-Sensitive Staphylococcus aureus Healthcare-Associated Infections Community Interface (HAIC) Case Report – 2018
HAIC Candidemia Case Report Form 0920-0978 CANDIDEMIA - CASE REPORT FORM
Influenza Hospitalization Surveillance Project Provider Vaccination History Fax Form (Children/Adults) 0920-0978 FluServ-NET Provider Vaccination History Fax Form
Influenza Hospitalization Surveillance Project Vaccination Telephone Script / Consent Form (Spanish) 0920-0978, 0920-0978 FluServ-NET Consent Form - Spanish ,   FluSurv-NET Vaccination Phone Script (English/Spanish)

  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 115,600 115,600 0 0 0 0
Annual Time Burden (Hours) 40,349 40,349 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$31,091,990
Yes Part B of Supporting Statement
    No
    No
No
No
No
Uncollected
Jeffrey Zirger 404 639-7118 [email protected]

  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.
06/05/2018