Information Collection

ABCs Case Report Form

IC 207646 under ICR 201801-0920-004 · 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⚠️ Notice: This information collection may be referencing outdated material.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 17AHK ABCs Case Report Form	Form and Instruction
17AHK Att. 1 - 2017 ACTIVE BACTERIAL CORE SURVEILLANCE CASE RE Att. 1 - 2017 ACTIVE BACTERIAL CORE SURVEILLANCE CASE REPORT.pdf	Form and Instruction

IC Title:

ABCs Case Report Form

Agency IC Tracking Number:

17AHK

Is this a Common Form? No

IC Status: Unchanged

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 and Instruction	17AHK	Att. 1 - 2017 ACTIVE BACTERIAL CORE SURVEILLANCE CASE REPORT	Att. 1 - 2017 ACTIVE BACTERIAL CORE SURVEILLANCE CASE REPORT.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Immunization Management

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	8,090	8,090
Annual IC Time Burden (Hours)	2,697	2,697
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.