Information Collection

Undetermined source of Elizabethkingia meningoseptica bloodstream infection among Wisconsin residents - Wisconsin, 2016

IC 220097 under ICR 201608-0920-012 · 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⚠️ Notice: This information collection may be referencing outdated material.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
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

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:

table that charts list of 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

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 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	25	25
Annual IC Time Burden (Hours)	32	32
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.