MRSA Infection Control Practices Survey

Methicillin-Resistant Staphylococcus aureus (MRSA) Infection Control Practices Survey

Documents and Forms

Document Name Document Type
Form No Number MRSA Infection Control Practices Survey Form and Instruction
No Number MRSA Infection Control Practices Survey Attachment E MRSA Infection Control Practices Survey.doc Form and Instruction
Attachment 5 - proposed survey_EIP-ABC version.doc Attachment 5 - Revised questionnaire IC Document

Information Collection (IC) Details

IC Title:	MRSA Infection Control Practices Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	No Number	MRSA Infection Control Practices Survey	Attachment E MRSA Infection Control Practices Survey.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 210	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	210	210
Annual IC Time Burden (Hours)	105	105
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment 5 - Revised questionnaire	Attachment 5 - proposed survey_EIP-ABC version.doc	03/23/2009

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