OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

[NCEZID] Emerging Infections Program

ICR 202312-0920-011 · 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 Available
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 MuGSI CA CP-CRE Health interview Form and Instruction Modified Repair queued
Form 0920-0978 HAIC MuGSI CA CP-CRE Health interview Form and Instruction Modified Missing upstream
Form 2024 HAIC- Laboratory Testing Practices for Candidemia Questionnaire Form and Instruction Modified Repair queued
Form 2024 HAIC- Laboratory Testing Practices for Candidemia Questionnaire Form and Instruction Modified Missing upstream
Form 0920-0978 HAIC Invasive Staphylococcus aureus Annual Surveillance Officers Survey Form and Instruction Unchanged Repair queued
Form 0920-0978 HAIC Invasive Staphylococcus aureus Annual Surveillance Officers Survey Form and Instruction Unchanged Repair queued
Form 0920-0978 HAIC Invasive Staphylococcus aureus Annual Laboratory Survey Form and Instruction Unchanged Repair queued
Form 0920-0978 HAIC Invasive Staphylococcus aureus Annual Laboratory Survey Form and Instruction Unchanged Repair queued
Form 0920-0978 HAIC- EIP C. difficile Surveillance Nursing Home Telephone Survey (LTCF) Form and Instruction Modified Repair queued
Form 0920-0978 HAIC- EIP C. difficile Surveillance Nursing Home Telephone Survey (LTCF) 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 Surveillance Officers Survey Form and Instruction Modified Repair queued
Form 0920-0978 HAIC- Annual Survey of Laboratory Testing Practices for C. difficile Infections Form and Instruction Modified Repair queued
Form 0920-0978 HAIC- Annual Survey of Laboratory Testing Practices for C. difficile Infections Form and Instruction Modified Repair queued
Form CS341327-A 7/31/20 Flu Surv NET Laboratory Survey Form Modified Available
Form CS341327-A 7/31/20 Flu Surv NET Laboratory Survey Form Modified Repair queued
Form Short Form 2024 HAIC Candidemia Case Report Form Form and Instruction Modified Repair queued
Form Short Form 2024 HAIC Candidemia Case Report Form Form and Instruction Modified Repair queued
Form CDC 52.15B Rev.07- HAIC Invasive Staphylococcus aureus Case Report – 2024 Form and Instruction Modified Repair queued
Form CDC 52.15B Rev.07- HAIC Invasive Staphylococcus aureus Case Report – 2024 Form and Instruction Modified Repair queued
Form 0920-0978 HAIC Multi-Site Gram-Negative Surveillance Initiative - Extended Spectrum Beta-Lactamase Producing Enterobacteriaceae (MuGSI-ESBL) Form Removed Repair queued
Form 0920-0978 HAIC Multi-Site Gram-Negative Surveillance Initiative - Extended Spectrum Beta-Lactamase Producing Enterobacteriaceae (MuGSI-ESBL) Form Removed Repair queued
Form 0920-0978-24BX FluSurv-Net Influenza Hospitalization Surveillance Project Provider Vaccination History Fax Form (Children/Adults) Form and Instruction Modified Repair queued
Form 0920-0978-24BX FluSurv-Net Influenza Hospitalization Surveillance Project Provider Vaccination History Fax Form (Children/Adults) Form and Instruction Modified Repair queued
Form 0920-0978 Influenza Hospitalization Surveillance Project Vaccination Telephone Script / Consent Form (Spanish) Form and Instruction Unchanged Repair queued
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 Available
Form 0920-0978 ABCs H. Influenzae Neonatal Sepsis Expanded Surveillance Form Form and Instruction Unchanged Repair queued
Form CS342262-A 9/20/20 HAIC Multi-Site Gram-Negative Surveillance Initiative (MUGSI) Case Report Form Form Modified Repair queued
Form CS342262-A 9/20/20 HAIC Multi-Site Gram-Negative Surveillance Initiative (MUGSI) Case Report Form Form Modified Repair queued
Form CS 342179-A 8/3/20 HAIC - CDI Case Report and Treatment Form Form and Instruction Modified Repair queued
Form CS 342179-A 8/3/20 HAIC - CDI Case Report and Treatment Form Form and Instruction Modified Repair queued
Form 0920-0978-24BX FluSurv-Net Influenza Hospitalization Surveillance Project Vaccination Phone Script and Consent Form (English/Spanish) Form and Instruction Modified Repair queued
Form 0920-0978-24BX FluSurv-Net Influenza Hospitalization Surveillance Project Vaccination Phone Script and Consent Form (English/Spanish) Form and Instruction Modified Repair queued
Form 0920-0978 FoodNet Hemolytic Uremic Syndrome (HUS) Form and Instruction Unchanged Repair queued
Form 0920-0978 FoodNet Hemolytic Uremic Syndrome (HUS) Form and Instruction Unchanged Repair queued
Form CS340190-A FluSurv-Net Influenza Hospitalization Surveillance Network Case Report Form Form and Instruction Modified Available
Form CS340190-A FluSurv-Net Influenza Hospitalization Surveillance 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 Unchanged Repair queued
Form 0920-0978 Active Bacterial Core Surveillance (ABCs) Neonatal Infection Expanded Tracking Form Form and Instruction Unchanged Repair queued
Form CDC 52.15A REV.8-2 ABCs Invasive Pneumococcal Disease in Children and Adults Form and Instruction Modified Repair queued
Form CDC 52.15A REV.8-2 ABCs Invasive Pneumococcal Disease in Children and Adults Form and Instruction Modified Repair queued
Form 0920-0978 HAIC Invasive Methicillin-resistant Staphylococcus aureus (MRSA) Form and Instruction Removed Repair queued
Form 0920-0978 HAIC Invasive Methicillin-resistant Staphylococcus aureus (MRSA) Form and Instruction Removed Repair queued
Form CDC 52.12A REV 201 2024 Active Bacterial Core Surveillance (ABCs) Case Report Form and Instruction Modified Available
Form CDC 52.12A REV 201 2024 Active Bacterial Core Surveillance (ABCs) Case Report Form and Instruction Modified Missing upstream
Att2_EIP2024_NonSub_Crosswalk_Dec21.docx Supplementary Document Uploaded 2023-12-28 Repair queued
Att2_EIP2024_NonSub_Crosswalk_Dec21.docx Supplementary Document Uploaded 2023-12-28 Repair queued
Att1_EIP2024_NonSub_DescriptionChanges_Dec21.docx Supplementary Document Uploaded 2023-12-28 Repair queued
Att1_EIP2024_NonSub_DescriptionChanges_Dec21.docx Supplementary Document Uploaded 2023-12-28 Repair queued
EIP 0920-0978_Non-sub change request.docx Justification for No Material/Nonsubstantive Change Uploaded 2023-12-28 Repair queued
EIP 0920-0978_Non-sub change request.docx Justification for No Material/Nonsubstantive Change Uploaded 2023-12-28 Missing upstream
Att10_COVID-19 Vaccination Status on FluSurv-NET Cases_20220808.pdf Supplementary Document Uploaded 2023-02-28 Available
Att10_COVID-19 Vaccination Status on FluSurv-NET Cases_20220808.pdf Supplementary Document 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
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 Repair queued
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 Available
EIP CDI ICMS PIA Signed 2.pdf Supplementary Document Uploaded 2022-04-25 Missing upstream
MuGSI PIA Signed.pdf Supplementary Document Uploaded 2022-04-25 Repair queued
MuGSI PIA Signed.pdf Supplementary Document Uploaded 2022-04-25 Missing upstream
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 Repair queued
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 Repair queued
SSB_EIP 2022 Revision_04052022.docx Supporting Statement B Uploaded 2022-04-25 Repair queued
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 HAIC MuGSI CA CP-CRE Health interview Form and Instruction Modified
253048 HAIC MuGSI CA CP-CRE Health interview Form and Instruction Modified
235058 HAIC- Laboratory Testing Practices for Candidemia Questionnaire Form and Instruction Modified
235058 HAIC- Laboratory Testing Practices for Candidemia Questionnaire Form and Instruction Modified
235057 HAIC Invasive Staphylococcus aureus Annual Surveillance Officers Survey Form and Instruction Unchanged
235057 HAIC Invasive Staphylococcus aureus Annual Surveillance Officers Survey Form and Instruction Unchanged
235056 HAIC Invasive Staphylococcus aureus Annual Laboratory Survey Form and Instruction Unchanged
235056 HAIC Invasive Staphylococcus aureus Annual Laboratory Survey Form and Instruction Unchanged
235055 HAIC- EIP C. difficile Surveillance Nursing Home Telephone Survey (LTCF) Form and Instruction Modified
235055 HAIC- EIP C. difficile Surveillance Nursing Home Telephone Survey (LTCF) Form and Instruction Modified
235054 HAIC- CDI Annual Surveillance Officers Survey Form and Instruction Modified
235054 HAIC- CDI Annual Surveillance Officers Survey Form and Instruction Modified
235053 HAIC- Annual Survey of Laboratory Testing Practices for C. difficile Infections Form and Instruction Modified
235053 HAIC- Annual Survey of Laboratory Testing Practices for C. difficile Infections 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 Other-Variable List 2024 Modified
231114 HAIC Candidemia Case Report Form Form and Instruction Modified
231114 HAIC Candidemia Case Report Form Form and Instruction Modified
231113 HAIC Invasive Staphylococcus aureus Case Report – 2024 Form and Instruction Modified
231113 HAIC Invasive Staphylococcus aureus Case Report – 2024 Form and Instruction Modified
231112 HAIC Multi-Site Gram-Negative Surveillance Initiative - Extended Spectrum Beta-Lactamase Producing Enterobacteriaceae (MuGSI-ESBL) Form Removed
231112 HAIC Multi-Site Gram-Negative Surveillance Initiative - Extended Spectrum Beta-Lactamase Producing Enterobacteriaceae (MuGSI-ESBL) Form Removed
231111 FluSurv-Net Influenza Hospitalization Surveillance Project Provider Vaccination History Fax Form (Children/Adults) Form and Instruction Modified
231111 FluSurv-Net Influenza Hospitalization Surveillance Project Provider Vaccination History Fax Form (Children/Adults) Form and Instruction Modified
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 Surveillance Initiative (MUGSI) Case Report Form Form Modified
217336 HAIC Multi-Site Gram-Negative Surveillance Initiative (MUGSI) Case Report Form Form Modified
217334 HAIC - CDI Case Report and Treatment Form Form and Instruction Modified
217334 HAIC - CDI Case Report and Treatment 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 FluSurv-Net Influenza Hospitalization Surveillance Project Vaccination Phone Script and Consent Form (English/Spanish) Form and Instruction Modified
207653 FluSurv-Net Influenza Hospitalization Surveillance Project Vaccination Phone Script and Consent Form (English/Spanish) Form and Instruction Modified
207652 FoodNet Hemolytic Uremic Syndrome (HUS) Form and Instruction Unchanged
207652 FoodNet Hemolytic Uremic Syndrome (HUS) Form and Instruction Unchanged
207651 FluSurv-Net Influenza Hospitalization Surveillance Network Case Report Form Form and Instruction Modified
207651 FluSurv-Net Influenza Hospitalization Surveillance Network Case Report Form Form and Instruction Modified
207649 Active Bacterial Core Surveillance (ABCs) Neonatal Infection Expanded Tracking Form Form and Instruction Unchanged
207649 Active Bacterial Core Surveillance (ABCs) Neonatal Infection Expanded Tracking Form Form and Instruction Unchanged
207648 ABCs Invasive Pneumococcal Disease in Children and Adults Form and Instruction Modified
207648 ABCs Invasive Pneumococcal Disease in Children and Adults Form and Instruction Modified
207647 HAIC Invasive Methicillin-resistant Staphylococcus aureus (MRSA) Form and Instruction Removed
207647 HAIC Invasive Methicillin-resistant Staphylococcus aureus (MRSA) Form and Instruction Removed
207646 2024 Active Bacterial Core Surveillance (ABCs) Case Report Form and Instruction Modified
207646 2024 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 No202302-0920-009
Agency Tracking No0920-0978-24BX
Date Submitted to OIRA2023-12-29
Requested Expiration Date1969-12-31