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Resistant Gram-Negative Bacilli Case Report Form

IC 217336 under ICR 201603-0920-001 · OMB 0920-0978.

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Resistant Gram-Negative Bacilli Case Report Form
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form NA 2015 Multi-site Gram-Negative Surveillance Initiative (MuGSI) Healthcare Associated Infection Community Interface (HAIC) Case Report Attachment_28_MDR GNB CRF_0920-0978.pdf NA Yes Yes Fillable Fileable
Form VERSION:01-2016 2016 Multi-site Gram Negative Surveillance Initiative (MuGSI) Healthcare Associated Infection Community Interface (HAIC) Case Report Att. 8 - MUGSI Form.pdf Yes Yes Fillable Fileable

Health Consumer Health and Safety

 

10 0
   
State, Local, and Tribal Governments
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 5,000 0 0 0 0 5,000
Annual IC Time Burden (Hours) 1,667 0 0 0 0 1,667
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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