Information Collection

Pseudomonas NICU_CA

IC 213233 under ICR 201311-0920-016 · OMB 0920-1011.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1011 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix 1_chart abstraction tool_2014019_Pseudomonas NICU _CA.docx	Other-WORD
Appendix_2_hand hygiene audit tool_2014019_Pseudomonas NICU_CA.doc	Other-WORD
Appendix 3_CLABSI Checklist_2014019_Pseudomonas NICU_CA.pdf	Other-WORD
Appendix 4_healthcare personnel interview_2014019_Pseudomonas NICU_CA.docx	Other-WORD
2014019-078_Pseudomonas NICU_CA.docx Request for Approval	IC Document
CA Letter of Invite Pseudomonas NICU.docx Letter of Invitation	IC Document
0920-1011 GenIC Request Pseudomonas NICU_CA.msg Completed GenIC Form	IC Document

IC Title:

Pseudomonas NICU_CA

Agency IC Tracking Number:

14AZS

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-WORD	Appendix_2_hand hygiene audit tool_2014019_Pseudomonas NICU_CA.doc	No	Fillable Printable
Other-WORD	Appendix 1_chart abstraction tool_2014019_Pseudomonas NICU _CA.docx	No	Fillable Fileable
Other-WORD	Appendix 3_CLABSI Checklist_2014019_Pseudomonas NICU_CA.pdf	No	Fillable Printable
Other-WORD	Appendix 4_healthcare personnel interview_2014019_Pseudomonas NICU_CA.docx	No	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 235

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	235	235
Annual IC Time Burden (Hours)	43	43
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Request for Approval	2014019-078_Pseudomonas NICU_CA.docx	09/24/2014
Letter of Invitation	CA Letter of Invite Pseudomonas NICU.docx	09/24/2014
Completed GenIC Form	0920-1011 GenIC Request Pseudomonas NICU_CA.msg	09/24/2014

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