Post-discharge Hospital Patients with MRSA (Case Patients) - Screening and Consent Process

Risk Factors for Invasive Methicillin-Resistant Staphylococcus aureus (MRSA) among Patients Recently Discharged from Acute Care Hospitals

Documents and Forms

Document Name Document Type
Attachment F-Screening questions HACO_revised 3_cleaned.docx Instruction
Attachment E - Verbal Consent.revised docx.docx Attachment E - Verbal Consent.revised docx IC Document

Information Collection (IC) Details

IC Title:	Post-discharge Hospital Patients with MRSA (Case Patients) - Screening and Consent Process	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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
Instruction			Attachment F-Screening questions HACO_revised 3_cleaned.docx		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 150	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	150	150
Annual IC Time Burden (Hours)	13	13
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment E - Verbal Consent.revised docx	Attachment E - Verbal Consent.revised docx.docx	02/14/2013

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