ABCs Invasive Pneumococcal Disease in Children Case Report Form

Active Bacterial Core Surveillance (ABCs)

Documents and Forms

Document Name Document Type
Form no number ABCs Invasive Pneumococcal Disease in Children Case Report Form Form
no number ABCs Invasive Pneumococcal Disease in Children Form Attachment 5_SPN_CRFexpanded_final ABCS Invasive Pneumo in Children Case ReportForm11 28 07recd041008.doc Form
Coversheet Attachment 5 Invasive Pneumo Disease in Children.doc Cover sheet for ABCs Invasive Pneumococcal Disease Case Report Form IC Document

Information Collection (IC) Details

IC Title:	ABCs Invasive Pneumococcal Disease in Children Case Report Form	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	no number	ABCs Invasive Pneumococcal Disease in Children Form	Attachment 5_SPN_CRFexpanded_final ABCS Invasive Pneumo in Children Case ReportForm11 28 07recd041008.doc		Yes	Yes	Fillable Printable

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 %

	Approved	Previously Approved
Annual Number of Responses for this IC	410	410
Annual IC Time Burden (Hours)	68	68
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Cover sheet for ABCs Invasive Pneumococcal Disease Case Report Form	Coversheet Attachment 5 Invasive Pneumo Disease in Children.doc	08/11/2008

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