Information Collection

ABCs H. Influenzae Neonatal Sepsis Expanded Surveillance Form

IC 220380 under ICR 201808-0920-022 · 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⚠️ Notice: This information collection may be referencing outdated material.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 H. Influenzae Neonatal Sepsis Expanded Surveillance Form	Form and Instruction
17AHK Att. 2 - ABCs H. Influenzae Neonatal Sepsis Expanded Sur Att. 2 - ABCs H. Influenzae Neonatal Sepsis Expanded Surveillance Form_HiNSES.pdf	Form and Instruction
0920-0978 ABCs H. Influenzae Neonatal Sepsis Expanded Surveillance Att 2- ABCs H. Influenzae Neonatal Sepsis Expanded Surveillance Form_HiN....pdf	Form and Instruction

IC Title:

ABCs H. Influenzae Neonatal Sepsis Expanded Surveillance Form

Agency IC Tracking Number:

0920-0978-18AXU

Is this a Common Form? No

IC Status: Modified

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 and Instruction	17AHK	Att. 2 - ABCs H. Influenzae Neonatal Sepsis Expanded Surveillance Form_HiNSES	Att. 2 - ABCs H. Influenzae Neonatal Sepsis Expanded Surveillance Form_HiNSES.pdf		Yes	Yes	Fillable Printable
Form and Instruction	0920-0978	ABCs H. Influenzae Neonatal Sepsis Expanded Surveillance Form	Att 2- ABCs H. Influenzae Neonatal Sepsis Expanded Surveillance Form_HiN....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	60	60
Annual IC Time Burden (Hours)	10	10
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.