2015 ABCs H. Influenzae Neonatal Sepsis Expanded Surveillance Form

Emerging Infections Program

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.