Information Collection

CDI Case Report Form

IC 217334 under ICR 201705-0920-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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
CDI Case Report Form	Form
Clostridium Difficile Infection (CDI) Surveillance Emerg Attachment_22_CDI CRF_0920-0978.pdf	Form
CDC Rev.10-2015 Clostridium Difficile Infection (CDI) Surveillance Emerg Att. 6 - CDI Case Report Form.pdf	Form
CDC Rev 09-2016 CLOSTRIDIUM DIFFICILE INFECTION (CDI) SURVEILLANCE EMERG Att. C - 2017 CDI CRF.pdf	Form

IC Title:

CDI Case Report Form

Agency IC Tracking Number:

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	NA	Clostridium Difficile Infection (CDI) Surveillance Emerging Infections Program Case Report	Attachment_22_CDI CRF_0920-0978.pdf	NA	Yes	Yes	Fillable Fileable
Form	CDC Rev.10-2015	Clostridium Difficile Infection (CDI) Surveillance Emerging Infections Program Case Report	Att. 6 - CDI Case Report Form.pdf		Yes	Yes	Fillable Fileable
Form	CDC Rev 09-2016	CLOSTRIDIUM DIFFICILE INFECTION (CDI) SURVEILLANCE EMERGING INFECTIONS PROGRAM CASE REPORT	Att. C - 2017 CDI CRF.pdf	NA	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	16,500	16,500
Annual IC Time Burden (Hours)	5,500	5,500
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.