ABCs Case Report Form

Emerging Infections Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0978 can be found here:

Documents and Forms

Document Name Document Type
ABCs Case Report Form Form
ABCsCRF 2015 Attachment 01_2015 ABCs CRF_OMB.PDF Form
CDC 52.15A REV. 10 2016 Active Bacterial Core Surveillance (ABCs) CASE REPO Att. 1 - ABCs Case Report Form.pdf Form

Information Collection (IC) Details

IC Title:	ABCs Case Report Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 301 Public Health Service Act

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	ABCsCRF 2015	Attachment 01_2015 ABCs CRF_OMB.PDF		Yes	Yes	Fillable Fileable
Form	CDC 52.15A REV. 10-2015	2016 Active Bacterial Core Surveillance (ABCs) CASE REPORT	Att. 1 - ABCs Case Report Form.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

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	8,090	8,090
Annual IC Time Burden (Hours)	2,697	2,697
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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