Undetermined source, mode of transmission, and risk factors for Candida auris infection - Colombia, 2016

Emergency Epidemic Investigation Data Collections - Expedited Reviews

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1011 can be found here:

Documents and Forms

Document Name Document Type
Undetermined source, mode of transmission, and risk factors for Candida auris infection - Colombia, 2016 Form and Instruction
Case Report Form - English Appendix 1a - Data Collection Instrument_Colombia C. auris (English).doc Form and Instruction
Case Report Form - Spanish Appendix 1b - Data Collection Instrument_Colombia C. auris (Spanish).doc Form and Instruction
HealthCare Provider Interview Appendix 2 - Healthcare Interview Questions.doc Form and Instruction
Patient Open-Ended Interview Appendix 3 - Patient Open-Ended Interviews.doc Form and Instruction
Burden Request Memo.msg Burden Request Memo - Email IC Document
Colombian Instituto Nacional de Salud - Candida Letter of Invite.pdf Letter of Invitation IC Document
1 GenIC Request Form - EEI Generic ICR_Colombia C auris.docx GenIC Request IC Document

Information Collection (IC) Details

IC Title:	Undetermined source, mode of transmission, and risk factors for Candida auris infection - Colombia, 2016	Agency IC Tracking Number:	0920-1011-16BEG

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Electronic Capability
Form and Instruction	NA	Case Report Form - English	Appendix 1a - Data Collection Instrument_Colombia C. auris (English).doc	NA	No	Paper Only
Form and Instruction	NA	Case Report Form - Spanish	Appendix 1b - Data Collection Instrument_Colombia C. auris (Spanish).doc	NA	No	Paper Only
Form and Instruction	NA	HealthCare Provider Interview	Appendix 2 - Healthcare Interview Questions.doc	NA	No	Paper Only
Form and Instruction	NA	Patient Open-Ended Interview	Appendix 3 - Patient Open-Ended Interviews.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: 22	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	70	70
Annual IC Time Burden (Hours)	35	35
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Burden Request Memo - Email	Burden Request Memo.msg	09/19/2016
Letter of Invitation	Colombian Instituto Nacional de Salud - Candida Letter of Invite.pdf	09/19/2016
GenIC Request	1 GenIC Request Form - EEI Generic ICR_Colombia C auris.docx	09/19/2016

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