Risk Factors for Community-Associated Clostridium difficile Infection through the Emerging Infections Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920 Pediatrice Control Subjects Telephone Interview	Form and Instruction	New	Available
Form 0920 Pediatric Control Subjects Screening Process	Form and Instruction	New	Available
Form 0920 Pediatric Case Telephone Interview	Form and Instruction	New	Repair queued
Form 0920 Pediatric Case Subject Screening Process	Form and Instruction	New	Available
Form 0920 Adult Control Subjects Telephone Interview	Form and Instruction	New	Repair queued
Form 0920 Adult Control Subjects Screening Process	Form and Instruction	New	Available
Form 0920 Adult Case Subjects Telephone Interview	Form and Instruction	New	Repair queued
Form 0920 Adult Case Subjects Screening Process	Form and Instruction	New	Repair queued
Supporting Statement Part B CA_CDI_1_21_14.docx	Supporting Statement B	Uploaded 2014-02-13	Available
SPANISH TRANSLATION_Attachment L_Adult Peds Consent CASE and CONTROL with and without HIPPA_1_24_14.doc	Supplementary Document	Uploaded 2014-02-17	Available
Rev Attachment H_CA CDI Protocol_IRB_Approved_1_24_14.docx	Supplementary Document	Uploaded 2014-02-17	Available
Attachment I_ 6542 Site Restricted New Submission Approval.docx	Supplementary Document	Uploaded 2014-02-17	Available
Attachment E_Verbal Consent Case and Control with and without HIPPA_1_24_14.docx	Supplementary Document	Uploaded 2014-02-17	Available
Attachment A Sec. 301 42 USC 241[1].pdf	Supplementary Document	Uploaded 2014-02-13	Available
SPANISH TRANSLATION_Attachment N_CA CDI Pediatric Patient Interview Form_1_24_14.doc	Supplementary Document	Uploaded 2014-02-17	Available
SPANISH TRANSLATION_Attachment K_Pediatric Case and Control Screening Forms_1_24_14.docx	Supplementary Document	Uploaded 2014-02-17	Available
SPANISH TRANSLATION_Attachment N_CA CDI Pediatric Patient Interview Form_1_24_14.doc	Supplementary Document	Uploaded 2014-02-17	Available
SPANISH TRANSLATION_Attachment K_Pediatric Case and Control Screening Forms_1_24_14.docx	Supplementary Document	Uploaded 2014-02-17	Available
SPANISH TRANSLATION_Attachment M_CA CDI Adult_ Patient Interview Form_1_24_14.doc	Supplementary Document	Uploaded 2014-02-17	Available
SPANISH TRANSLATION_Attachment J_Adult Case and Control Screening Forms 1_24_14.docx	Supplementary Document	Uploaded 2014-02-17	Available
SPANISH TRANSLATION_Attachment M_CA CDI Adult_ Patient Interview Form_1_24_14.doc	Supplementary Document	Uploaded 2014-02-17	Available
SPANISH TRANSLATION_Attachment J_Adult Case and Control Screening Forms 1_24_14.docx	Supplementary Document	Uploaded 2014-02-14	Available
Supporting Statement Part A CA_CDI_1_31_14.docx	Supporting Statement A	Uploaded 2014-02-13	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
210434	Pediatrice Control Subjects Telephone Interview	Form and Instruction	New
210433	Pediatric Control Subjects Screening Process	Form and Instruction	New
210432	Pediatric Case Telephone Interview	Form and Instruction	New
210431	Pediatric Case Subject Screening Process	Form and Instruction	New
210430	Adult Control Subjects Telephone Interview	Form and Instruction	New
210429	Adult Control Subjects Screening Process	Form and Instruction	New
210428	Adult Case Subjects Telephone Interview	Form and Instruction	New
210427	Adult Case Subjects Screening Process	Form and Instruction	New

ICR Details

OMB Control No: 0920-1013	ICR Reference No: 201402-0920-014
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 21443
Title: Risk Factors for Community-Associated Clostridium difficile Infection through the Emerging Infections Program
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/07/2014
	Date Received in OIRA: 02/20/2014
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2017	36 Months From Approved
Responses	904	0	0
Time Burden (Hours)	201	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: This is a submission to collect data on risk factors for contracting C. diff infection through the community like in outpatient healthcare settings, homes, etc.

---

Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 54472	09/04/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 8460	02/12/2014
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 8

table that charts list of burden

IC Title	Form No.	Form Name
Adult Case Subjects Screening Process	0920	Attachment C_Adult case and control Screening forms
Adult Case Subjects Telephone Interview	0920	Attachment F_Adult Interview Form
Adult Control Subjects Screening Process	0920	Attachment C_Adult case and control Screening forms
Adult Control Subjects Telephone Interview	0920	Attachment F_Adult Interview Form
Pediatric Case Subject Screening Process	0920	Attachment D_Pediatric case and control Screening Forms
Pediatric Case Telephone Interview	0920	Attachment G_Pediatric Interview Form
Pediatric Control Subjects Screening Process	0920	Attachment D_Pediatric case and control Screening Forms
Pediatrice Control Subjects Telephone Interview	0920	Attachment G_Pediatric Interview Form

---

ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	904	0	0	904	0	0
Annual Time Burden (Hours)	201	0	0	201	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new collection

---

Annual Cost to Federal Government: $230,764

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 02/20/2014

---