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Undetermined source of Elizabethkingia meningoseptica bloodstream infection among Wisconsin residents - Wisconsin, 2016
Emergency Epidemic Investigation Data Collections - Expedited Reviews
OMB: 0920-1011
IC ID: 220097
OMB.report
HHS/CDC
OMB 0920-1011
ICR 201604-0920-011
IC 220097
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1011 can be found here:
2022-10-07 - Revision of a currently approved collection
2022-01-13 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Undetermined source of Elizabethkingia meningoseptica bloodstream infection among Wisconsin residents - Wisconsin, 2016
Form and Instruction
Elizabethkingia Meningoseptica Case Investigation Form
Appendix 1. Case Investigation Form.doc
Form and Instruction
EKM LOI scanned signed let 2 9 16.pdf
Letter of Invitation - Wisconsin
IC Document
2016XXX-XXX bloodstream infection_WI.docx
Request for Emergency GenIC - EKM Wiconsin
IC Document
Burden Memo EKM_Wisconsin.msg
Burden Memo - EKM_Wisconsin
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Undetermined source of Elizabethkingia meningoseptica bloodstream infection among Wisconsin residents - Wisconsin, 2016
Agency IC Tracking Number:
IC Status:
Unchanged
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
Form and Instruction
NA
Elizabethkingia Meningoseptica Case Investigation Form
Appendix 1. Case Investigation Form.doc
NA
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
Privacy Act System of Records
Title:
09-20-0113 Epidemic Investigation Case Records
FR Citation:
51 FR 42466
Number of Respondents:
25
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Requested
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
25
0
0
0
0
25
Annual IC Time Burden (Hours)
32
0
0
0
0
32
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Letter of Invitation - Wisconsin
EKM LOI scanned signed let 2 9 16.pdf
02/12/2016
Request for Emergency GenIC - EKM Wiconsin
2016XXX-XXX bloodstream infection_WI.docx
02/12/2016
Burden Memo - EKM_Wisconsin
Burden Memo EKM_Wisconsin.msg
02/12/2016
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.