Information Collection

Invasive Methicillin - Resistant - Staphylococcus aureus ABCs Case Report Form

IC 207647 under ICR 201612-0920-015 · OMB 0920-0978.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0978 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Invasive Methicillin - Resistant - Staphylococcus aureus ABCs Case Report Form	Form
Invasive Methicillin-Resistant Staph Attachment2_ABCs_MRSA_CRF_Feb2014.pdf	Form
CDC 52.15B Rev 10- Healthcare-Associated Infections Community Interface (HA Att. 7 - MRSA Form.pdf	Form
CDC 52.15B Rev 09- Invasive Methicillin-Resistant Staphylococcus aureus HAI Att. E - 16_270050_MRSA2017_OMB_v2.pdf	Form

IC Title:

Invasive Methicillin - Resistant - Staphylococcus aureus ABCs Case Report Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 301 Public Health Service Act

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	none	Invasive Methicillin-Resistant Staph	Attachment2_ABCs_MRSA_CRF_Feb2014.pdf		Yes	Yes	Fillable Fileable
Form	CDC 52.15B Rev 10-2015	Healthcare-Associated Infections Community Interface (HACI) Case Report -2016	Att. 7 - MRSA Form.pdf		Yes	Yes	Fillable Fileable
Form	CDC 52.15B Rev 09-2016	Invasive Methicillin-Resistant Staphylococcus aureus HAIC Case Report - 2017	Att. E - 16_270050_MRSA2017_OMB_v2.pdf	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	6,090	6,090
Annual IC Time Burden (Hours)	2,030	2,030
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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