ABCs Case Report 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⚠️ Notice: This information collection may be referencing outdated material.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 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

Information Collection (IC) Details

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:

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 %

	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

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.