OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

[NCEZID] Emerging Infections Program

ICR 202302-0920-009 · OMB 0920-0978 · Active

Forms and Documents
DocumentTypeStatusAvailability
Form 0920-0978 HAIC Death Ascertainment Project Form and Instruction Unchanged Repair queued
Form 0920-0978 HAIC Death Ascertainment Project Form and Instruction Unchanged Repair queued
Form 0920-0978 HAIC Multi-site Gram-negative Surveillance Initiative (MuGSI) Supplemental Surveillance Officer Survey Form and Instruction Unchanged Repair queued
Form 0920-0978 HAIC Multi-site Gram-negative Surveillance Initiative (MuGSI) Supplemental Surveillance Officer Survey Form and Instruction Unchanged Repair queued
Form 0920-0978 Community-Associated CP-CRE Interview Form and Instruction Unchanged Repair queued
Form 0920-0978 Community-Associated CP-CRE Interview Form and Instruction Unchanged Missing upstream
Form 0920-0978 HAIC Candidemia Periodic Laboratory Survey Form and Instruction Modified Repair queued
Form 0920-0978 HAIC Candidemia Periodic Laboratory Survey Form and Instruction Modified Repair queued
Form 0920-0978 HAIC Invasive Staphylococcus aureus Annual Surveillance Officers Survey Form and Instruction Modified Repair queued
Form 0920-0978 HAIC Invasive Staphylococcus aureus Annual Surveillance Officers Survey Form and Instruction Modified Repair queued
Form 0920-0978 HAIC Invasive Staphylococcus aureus Annual Laboratory Survey Form and Instruction Modified Available
Form 0920-0978 HAIC Invasive Staphylococcus aureus Annual Laboratory Survey Form and Instruction Modified Repair queued
Form 0920-0978 HAIC CDI LTCF Survey Form and Instruction Unchanged Repair queued
Form 0920-0978 HAIC CDI LTCF Survey Form and Instruction Unchanged Repair queued
Form 0920-0978 HAIC CDI Annual Surveillance Officers Survey Form and Instruction Modified Repair queued
Form 0920-0978 HAIC CDI Annual Surveillance Officers Survey Form and Instruction Modified Repair queued
Form 0920-0978 HAIC CDI Annual Laboratory Survey Form and Instruction Modified Available
Form 0920-0978 HAIC CDI Annual Laboratory Survey Form and Instruction Modified Repair queued
Form 0920-0978 Flu Surv NET Laboratory Survey Form Modified Repair queued
Form 0920-0978 Flu Surv NET Laboratory Survey Form Modified Repair queued
Form 0920-0978 Foodnet Clinical Laboratory Practices and Testing Volume Form and Instruction Modified Repair queued
Form 0920-0978 Foodnet Clinical Laboratory Practices and Testing Volume Form and Instruction Modified Missing upstream
Form 0920-0978 HAIC Candidemia Case Report Form Form and Instruction Modified Repair queued
Form 0920-0978 HAIC Candidemia Case Report Form Form and Instruction Modified Repair queued
Form 0920-0978 HAIC Invasive Methicillin-Sensitive Staphylococcus aureus (MSSA) Form and Instruction Modified Repair queued
Form 0920-0978 HAIC Invasive Methicillin-Sensitive Staphylococcus aureus (MSSA) Form and Instruction Modified Missing upstream
Form 0920-0978 HAIC Multi-Site Gram-Negative Surveillance Initiative - Extended Spectrum Beta-Lactamase Producing Enterobacteriaceae (MuGSI-ESBL) Form Modified Repair queued
Form 0920-0978 HAIC Multi-Site Gram-Negative Surveillance Initiative - Extended Spectrum Beta-Lactamase Producing Enterobacteriaceae (MuGSI-ESBL) Form Modified Repair queued
Form 0920-0978 Influenza Hospitalization Surveillance Project Provider Vaccination History Fax Form (Children/Adults) Form and Instruction Unchanged Available
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 Influenza Hospitalization Surveillance Project Vaccination Telephone Script / Consent Form (Spanish) Form and Instruction Unchanged Repair queued
Form 0920-0978 ABCs Severe GAS Infection Supplemental Form Form and Instruction Unchanged Repair queued
Form 0920-0978 ABCs Severe GAS Infection Supplemental Form Form and Instruction Unchanged Repair queued
Form 0920-0978 ABCs H. Influenzae Neonatal Sepsis Expanded Surveillance Form Form and Instruction Unchanged Repair queued
Form 0920-0978 ABCs H. Influenzae Neonatal Sepsis Expanded Surveillance Form Form and Instruction Unchanged Missing upstream
Form 0920-0978 HAIC Multi-Site Gram-Negative Bacilli Case Report Form (MuGSI-CRE/CRAB) Form Modified Available
Form 0920-0978 HAIC Multi-Site Gram-Negative Bacilli Case Report Form (MuGSI-CRE/CRAB) Form Modified Repair queued
Form 0920-0978 HAIC CDI Case Report Form Form and Instruction Modified Repair queued
Form 0920-0978 HAIC CDI Case Report Form Form and Instruction Modified Repair queued
Form 0920-0978 Influenza Hospitalization Surveillance Project Vaccination Telephone Script / Consent Form (English) Form and Instruction Unchanged Available
Form 0920-0978 Influenza Hospitalization Surveillance Project Vaccination Telephone Script / Consent Form (English) Form and Instruction Unchanged Repair queued
Form 0920-0978 FoodNet Hemolytic Uremic Syndrome (HUS) Form and Instruction Modified Repair queued
Form 0920-0978 FoodNet Hemolytic Uremic Syndrome (HUS) Form and Instruction Modified Repair queued
Form 0920-0978 Influenza Hospitalization Surveilance Network Case Report Form Form and Instruction Modified Repair queued
Form 0920-0978 Influenza Hospitalization Surveilance Network Case Report Form Form and Instruction Modified Repair queued
Form 0920-0978 Active Bacterial Core Surveillance (ABCs) Neonatal Infection Expanded Tracking Form Form and Instruction Modified Repair queued
Form 0920-0978 Active Bacterial Core Surveillance (ABCs) Neonatal Infection Expanded Tracking Form Form and Instruction Modified Repair queued
Form 0920-0978 ABCs Invasive Pneumococcal Disease in Children Form and Instruction Unchanged Repair queued
Form 0920-0978 ABCs Invasive Pneumococcal Disease in Children Form and Instruction Unchanged Repair queued
Form 0920-0978 HAIC Invasive Methicillin-resistant Staphylococcus aureus (MRSA) Form and Instruction Modified Available
Form 0920-0978 HAIC Invasive Methicillin-resistant Staphylococcus aureus (MRSA) Form and Instruction Modified Repair queued
Form 0920-0978 2023 Active Bacterial Core Surveillance (ABCs) Case Report Form and Instruction Modified Repair queued
Form 0920-0978 2023 Active Bacterial Core Surveillance (ABCs) Case Report Form and Instruction Modified Repair queued
Att10_COVID-19 Vaccination Status on FluSurv-NET Cases_20220808.pdf Supplementary Document Uploaded 2023-02-28 Repair queued
Att10_COVID-19 Vaccination Status on FluSurv-NET Cases_20220808.pdf Supplementary Document Uploaded 2023-02-28 Missing upstream
EIP 0920-0978_Non-sub change request_Oct2022FOR2023.docx Justification for No Material/Nonsubstantive Change Uploaded 2023-02-28 Repair queued
EIP 0920-0978_Non-sub change request_Oct2022FOR2023.docx Justification for No Material/Nonsubstantive Change Uploaded 2023-02-28 Repair queued
Att1_EIP2023_NonSub_DescriptionChanges_OCT2022.docx Justification for No Material/Nonsubstantive Change Uploaded 2023-02-28 Repair queued
Att1_EIP2023_NonSub_DescriptionChanges_OCT2022.docx Justification for No Material/Nonsubstantive Change Uploaded 2023-02-28 Repair queued
Att2_EIP2023_NonSub_Crosswalk_OCT2022.docx Supplementary Document Uploaded 2023-02-28 Available
Att2_EIP2023_NonSub_Crosswalk_OCT2022.docx Supplementary Document Uploaded 2023-02-28 Repair queued
Att23- HAIC CA CP-CRE interview project manual.pdf Supplementary Document Uploaded 2022-04-25 Repair queued
Att23- HAIC CA CP-CRE interview project manual.pdf Supplementary Document Uploaded 2022-04-25 Repair queued
EIP CDI ICMS PIA Signed 2.pdf Supplementary Document Uploaded 2022-04-25 Repair queued
EIP CDI ICMS PIA Signed 2.pdf Supplementary Document Uploaded 2022-04-25 Repair queued
MuGSI PIA Signed.pdf Supplementary Document Uploaded 2022-04-25 Repair queued
MuGSI PIA Signed.pdf Supplementary Document Uploaded 2022-04-25 Repair queued
Att2- 60-Day FRN_2022.docx Supplementary Document Uploaded 2022-04-25 Repair queued
Att2- 60-Day FRN_2022.docx Supplementary Document Uploaded 2022-04-25 Missing upstream
Att1- Authorizing_Regulations_T42_section_241.pdf Supplementary Document Uploaded 2022-04-25 Repair queued
Att1- Authorizing_Regulations_T42_section_241.pdf Supplementary Document Uploaded 2022-04-25 Missing upstream
SSB_EIP 2022 Revision_04052022.docx Supporting Statement B Uploaded 2022-04-25 Available
SSB_EIP 2022 Revision_04052022.docx Supporting Statement B Uploaded 2022-04-25 Repair queued
SSA_EIP 2022 Revision_04212022_SMN_Clean final_Updated_020723_highlighted edits_final OMB_final.docx Supporting Statement A Uploaded 2023-02-08 Available
SSA_EIP 2022 Revision_04212022_SMN_Clean final_Updated_020723_highlighted edits_final OMB_final.docx Supporting Statement A Uploaded 2023-02-08 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
253051 HAIC Death Ascertainment Project Form and Instruction Unchanged
253051 HAIC Death Ascertainment Project Form and Instruction Unchanged
253049 HAIC Multi-site Gram-negative Surveillance Initiative (MuGSI) Supplemental Surveillance Officer Survey Form and Instruction Unchanged
253049 HAIC Multi-site Gram-negative Surveillance Initiative (MuGSI) Supplemental Surveillance Officer Survey Form and Instruction Unchanged
253048 Community-Associated CP-CRE Interview Form and Instruction Unchanged
253048 Community-Associated CP-CRE Interview Form and Instruction Unchanged
235058 HAIC Candidemia Periodic Laboratory Survey Form and Instruction Modified
235058 HAIC Candidemia Periodic Laboratory Survey Form and Instruction Modified
235057 HAIC Invasive Staphylococcus aureus Annual Surveillance Officers Survey Form and Instruction Modified
235057 HAIC Invasive Staphylococcus aureus Annual Surveillance Officers Survey Form and Instruction Modified
235056 HAIC Invasive Staphylococcus aureus Annual Laboratory Survey Form and Instruction Modified
235056 HAIC Invasive Staphylococcus aureus Annual Laboratory Survey Form and Instruction Modified
235055 HAIC CDI LTCF Survey Form and Instruction Unchanged
235055 HAIC CDI LTCF Survey Form and Instruction Unchanged
235054 HAIC CDI Annual Surveillance Officers Survey Form and Instruction Modified
235054 HAIC CDI Annual Surveillance Officers Survey Form and Instruction Modified
235053 HAIC CDI Annual Laboratory Survey Form and Instruction Modified
235053 HAIC CDI Annual Laboratory Survey Form and Instruction Modified
235052 Flu Surv NET Laboratory Survey Form Modified
235052 Flu Surv NET Laboratory Survey Form Modified
235051 Foodnet Clinical Laboratory Practices and Testing Volume Form and Instruction Modified
235051 Foodnet Clinical Laboratory Practices and Testing Volume Form and Instruction Modified
231114 HAIC Candidemia Case Report Form Form and Instruction Modified
231114 HAIC Candidemia Case Report Form Form and Instruction Modified
231113 HAIC Invasive Methicillin-Sensitive Staphylococcus aureus (MSSA) Form and Instruction Modified
231113 HAIC Invasive Methicillin-Sensitive Staphylococcus aureus (MSSA) Form and Instruction Modified
231112 HAIC Multi-Site Gram-Negative Surveillance Initiative - Extended Spectrum Beta-Lactamase Producing Enterobacteriaceae (MuGSI-ESBL) Form Modified
231112 HAIC Multi-Site Gram-Negative Surveillance Initiative - Extended Spectrum Beta-Lactamase Producing Enterobacteriaceae (MuGSI-ESBL) Form Modified
231111 Influenza Hospitalization Surveillance Project Provider Vaccination History Fax Form (Children/Adults) 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
231110 Influenza Hospitalization Surveillance Project Vaccination Telephone Script / Consent Form (Spanish) Form and Instruction Unchanged
230869 ABCs Severe GAS Infection Supplemental Form Form and Instruction Unchanged
230869 ABCs Severe GAS Infection Supplemental Form Form and Instruction Unchanged
220380 ABCs H. Influenzae Neonatal Sepsis Expanded Surveillance Form Form and Instruction 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 Modified
217336 HAIC Multi-Site Gram-Negative Bacilli Case Report Form (MuGSI-CRE/CRAB) Form Modified
217334 HAIC CDI Case Report Form Form and Instruction Modified
217334 HAIC CDI Case Report Form Form and Instruction Modified
207663 FoodNet Yersinia Other-Variable list Modified
207662 FoodNet Vibrio Other-Variable list Modified
207661 FoodNet Shigella Other-Variable list Modified
207660 FoodNet Shiga toxin producing E. coli Other-Variable list Modified
207659 FoodNet Salmonella Other-Variable list Modified
207658 FoodNet Listeria monocytogenes Other-Variable list Modified
207657 FoodNet Cyclospora Other-Variable list Modified
207655 FoodNet Campylobacter Other-Variable list Modified
207653 Influenza Hospitalization Surveillance Project Vaccination Telephone Script / Consent Form (English) Form and Instruction Unchanged
207653 Influenza Hospitalization Surveillance Project Vaccination Telephone Script / Consent Form (English) Form and Instruction Unchanged
207652 FoodNet Hemolytic Uremic Syndrome (HUS) Form and Instruction Modified
207652 FoodNet Hemolytic Uremic Syndrome (HUS) Form and Instruction Modified
207651 Influenza Hospitalization Surveilance Network Case Report Form Form and Instruction Modified
207651 Influenza Hospitalization Surveilance Network Case Report Form Form and Instruction Modified
207649 Active Bacterial Core Surveillance (ABCs) Neonatal Infection Expanded Tracking Form Form and Instruction Modified
207649 Active Bacterial Core Surveillance (ABCs) Neonatal Infection Expanded Tracking Form Form and Instruction Modified
207648 ABCs Invasive Pneumococcal Disease in Children Form and Instruction Unchanged
207648 ABCs Invasive Pneumococcal Disease in Children Form and Instruction Unchanged
207647 HAIC Invasive Methicillin-resistant Staphylococcus aureus (MRSA) Form and Instruction Modified
207647 HAIC Invasive Methicillin-resistant Staphylococcus aureus (MRSA) Form and Instruction Modified
207646 2023 Active Bacterial Core Surveillance (ABCs) Case Report Form and Instruction Modified
207646 2023 Active Bacterial Core Surveillance (ABCs) Case Report Form and Instruction Modified
ICR Details
StatusActive
Agency/SubagencyHHS/CDC
OMB Control No0920-0978
Type of Information CollectionNo material or nonsubstantive change to a currently approved collection
Previous ICR Reference No202204-0920-008
Agency Tracking No0920-0978-23CP
Date Submitted to OIRA2023-03-01
Requested Expiration Date1969-12-31