Information Collection

Community-Associated CP-CRE Interview

IC 253048 under ICR 202604-0920-003 · OMB 0920-0978.

Documents and Forms

Document Name Document Type
Form HAIC.400.2 Community-Associated CP-CRE Interview Community-Associated CP-CRE Interview Form and Instruction
HAIC.400.2 Community-Associated CP-CRE Interview HAIC.400.2 HAIC MuGSI CA CP-CRE Health interview.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Community-Associated CP-CRE Interview	Agency IC Tracking Number:	0920-0978

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	HAIC.400.2	Community-Associated CP-CRE Interview	HAIC.400.2 HAIC MuGSI CA CP-CRE Health interview.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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