Emerging Infections Program

ICR 201801-0920-004

OMB: 0920-0978

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Unchanged
Form
Modified
Form
Removed
Form
Modified
Form
Unchanged
Form
Unchanged
Form
Unchanged
Form
Unchanged
Form
Unchanged
Form and Instruction
Unchanged
Form and Instruction
Unchanged
Form
Modified
Form and Instruction
Unchanged
Justification for No Material/Nonsubstantive Change
2018-01-23
Justification for No Material/Nonsubstantive Change
2017-05-03
Justification for No Material/Nonsubstantive Change
2016-12-28
Supplementary Document
2016-12-28
Justification for No Material/Nonsubstantive Change
2016-03-02
Supplementary Document
2015-07-07
Supplementary Document
2015-07-07
Supplementary Document
2015-07-07
Supporting Statement B
2016-02-24
Supporting Statement A
2016-02-24
Justification for No Material/Nonsubstantive Change
2015-02-17
ICR Details
0920-0978 201801-0920-004
Historical Active 201705-0920-001
HHS/CDC 0920-0978-18LX
Emerging Infections Program
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 01/29/2018
Retrieve Notice of Action (NOA) 01/24/2018
Previous terms continue: Approved consistent with the understanding that this consolidation will result in the modification and/or discontinuation of related CDC ICRs.
  Inventory as of this Action Requested Previously Approved
02/28/2019 02/28/2019 02/28/2019
62,820 0 80,420
22,090 0 22,473
0 0 0

disease-specific data elements for HAIC only. As a result of proposed changes, the estimated annualized burden is expected to decrease by 383 hours, from 22,473 to 22,090. The forms for which approval for changes and additions are being sought include: 1. 2018 Resistant Gram-Negative Bacilli (MuGSI) Case Report Form for Carbapenem-resistant Enterobacteriaceae and Acinetobacter baumannii (Att. 1) 2. 2018 Invasive Methicillin-resistant Staphylococcus aureus (MRSA) Infection Case Report Form (Att. 2) 3. 2018 Clostridium difficile Infection (CDI) Case Report Form (Att. 3). NOTE: the 2018 form combines two approved 2017 forms (the CDI Case Report Form and the CDI Treatment Form) into a single form. 4. Persons in the Community with Clostridium difficile infection (CDI): Screening Form (discontinued) 5. Persons in the Community with Clostridium difficile infection (CDI): Telephone Interview Form (discontinued)

US Code: 42 USC 301 Name of Law: Public Health Service Act
  
None

Not associated with rulemaking

  80 FR 26051 05/06/2015
80 FR 39780 07/10/2015
No

21
IC Title Form No. Form Name
CDI Screening Form
CDI Telephone Interview
Shigella
Vibrio
Yersinia
CDI Treatment Form NA EIP CDI Surveillance: CDI Case Treatment Questionnaire
Resistant Gram-Negative Bacilli Case Report Form VERSION: 11/2017, VERSION:01-2016, NA, 0920-09078 2018 Multi-Site Gram-Negative Surveillance Initiative (MuGSI) Healthcare Associated Infection Community Interface (HAIC) Case Report ,   2015 Multi-site Gram-Negative Surveillance Initiative (MuGSI) Healthcare Associated Infection Community Interface (HAIC) Case Report ,   2016 Multi-site Gram Negative Surveillance Initiative (MuGSI) Healthcare Associated Infection Community Interface (HAIC) Case Report ,   2017 Multi-site Gram-Negative Surveillance Initiative (MuGSI) HAIC Case Report
CDI Case Report Form CDC Rev 09-2016, CDC Rev.10-2015, NA, 0920-0978 Clostridium Difficile Infection (CDI) Surveillance Emerging Infections Program Case Report ,   Clostridium Difficile Infection (CDI) Surveillance Emerging Infections Program Case Report ,   Clostridium Difficile Infection (CDI) Surveillance Emerging Infections Program Case Report ,   CLOSTRIDIUM DIFFICILE INFECTION (CDI) SURVEILLANCE EMERGING INFECTIONS PROGRAM CASE REPORT
Shiga toxin producing E. coli
2015 ABCs H. Influenzae Neonatal Sepsis Expanded Surveillance Form 17AHK Att. 2 - ABCs H. Influenzae Neonatal Sepsis Expanded Surveillance Form_HiNSES
ABCs Case Report Form 17AHK Att. 1 - 2017 ACTIVE BACTERIAL CORE SURVEILLANCE CASE REPORT
ABCs Non Bacteremic Pneumococcal Disease CDC, none Non Bacteremic Pneumococcal 2015 ,   2016 Surveillance for Non-Invasive Penumococcal Pneumonia (SNiPP)
Invasive Methicillin-Resistant - Staphylococcus aureus ABCs Case Report Form 0920-0978, CDC 52.15B Rev 09-2016, none, CDC 52.15B Rev 10-2015 Invasive Methicillin-Resistant Staph ,   Invasive Methicillin-Resistant Staphylococcus aureaus Healthcare-Associated Infections Community Interface(HAIC) Case Report - 2018 ,   Healthcare-Associated Infections Community Interface (HACI) Case Report -2016 ,   Invasive Methicillin-Resistant Staphylococcus aureus HAIC Case Report - 2017
ABCs Invasive Pneumococcal Disease in Children 17AHK Att. 4 - ACTIVE BACTERIAL CORE SURVEILLANCE (ABCs) INVASIVE PNEUMOCOCCAL DISEASE IN CHILDREN
ABCs Neonatal Infection Expanded Tracking Form 17AHK Att. 3 - ACTIVE BACTERIAL CORE SURVEILLANCE (ABCs) Neonatal Infection Expanded Tracking Form
FluSurv-NET Influenza Hospitalization Surveilance Project Case Report Form CDC Rev 07-2015, none FluSurv-NET Influenza Hospital Surveillance Project ,   2015-16 FluSurv-NET Influenza Hospitalization Surveillance Project Case Report Form
Hemolytic Uremic Syndrome (HUS) NA FoodNet Hemolytic Uremic Syndrome (HUS) Surveillance
Influenza Hospitalization Surveillance Project Vaccination Telephone Survey none Vaccination Telephone Survey - English
FluSurv-Net Project Consent Form none Consent
Campylobacter
Cryptosporidium
Cyclospora
Listeria monocytogenes
Salmonella

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 62,820 80,420 0 -17,600 0 0
Annual Time Burden (Hours) 22,090 22,473 0 -383 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
Yes
Changing Forms
The submission of this Non-Substantive Change Request entails an overall decrease in Burden Hours due to the changes in the following forms associated with 0920-0978 Emerging Infections Program: 2018 Resistant Gram-Negative Bacilli (MuGSI) Case Report Form 2018 Invasive Methicillin-resistant Staphylococcus aureus (MRSA) Infection Case Report Form 2018 Clostridium difficile Infection (CDI) Case Report Form Additionally the following instruments were discontinued: Clostridium difficile infection (CDI): Screening Form Clostridium difficile infection (CDI): Telephone Interview Form

$20,221,865
Yes Part B of Supporting Statement
    No
    No
No
No
No
Uncollected
Jeffrey Zirger 404 639-7118 [email protected]

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
01/24/2018


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