Information Collection

2015 ABCs H. Influenzae Neonatal Sepsis Expanded Surveillance Form

IC 220380 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⚠️ Notice: This information collection may be referencing outdated material.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
Form CDC 10-2015 2015 ABCs H. Influenzae Neonatal Sepsis Expanded Surveillance Form	Form
CDC 10-2015 2015 ABCs H. Influenzae Neonatal Sepsis Expanded Surveil Att. 3 - HiNSES Case Report Form.pdf	Form

IC Title:

2015 ABCs H. Influenzae Neonatal Sepsis Expanded Surveillance Form

Agency IC Tracking Number:

16SA

Is this a Common Form? No

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	CDC 10-2015	2015 ABCs H. Influenzae Neonatal Sepsis Expanded Surveillance Form	Att. 3 - HiNSES Case Report Form.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

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	60	60
Annual IC Time Burden (Hours)	10	10
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.