Information Collection

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

IC 223579 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⚠️ Notice: This information collection may be referencing outdated material.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
Case Report Form - English Undetermined source, mode of transmission, and risk factors for Candida auris infection - Colombia, 2016	Form and Instruction
Case Report Form - Spanish Undetermined source, mode of transmission, and risk factors for Candida auris infection - Colombia, 2016	Form and Instruction
HealthCare Provider Interview Undetermined source, mode of transmission, and risk factors for Candida auris infection - Colombia, 2016	Form and Instruction
Patient Open-Ended Interview 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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.