Information Collection

Records abstraction form for patients who suffered from Serratia marcescens infection

IC 231226 under ICR 201804-0920-013 · OMB 0920-1226.

Documents and Forms

Document Name Document Type
Records abstraction form for patients who suffered from Serratia marcescens infection Form and Instruction
Undetermined cause of Serratia marcescens infections - M Att 3 - Patient records abstraction tool.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Records abstraction form for patients who suffered from Serratia marcescens infection	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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 and Instruction	NA	Undetermined cause of Serratia marcescens infections - Multiple States,2018 Records Abstraction Tool	Att 3 - Patient records abstraction tool.pdf	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: 09-20-0136 - Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 62812

Number of Respondents: 50	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	200	200
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.