Emerging Infections Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-0978 Death Ascertainment Project Variables	Form and Instruction	New	Available
Form 0920-0978 HAIC Death Ascertainment Project	Form and Instruction	New	Repair queued
Form 0920-0978 MuGSI SO Survey Questionnaire	Form and Instruction	New	Repair queued
Form 0920-0978 HAIC Multi-site Gram-negative Surveillance Initiative (MuGSI) Supplemental Surveillance Officer Survey	Form and Instruction	New	Repair queued
Form 0920-0978 CA CP-CRE Survey Questionnaire	Form and Instruction	New	Available
Form 0920-0978 Community-Associated CP-CRE Interview	Form and Instruction	New	Repair queued
Candidemia Lab Survey	Form and Instruction	Modified	Available
HAIC Candidemia Periodic Laboratory Survey	Form and Instruction	Modified	Repair queued
Form 0920-0978 2019 HAIC Invasive Staphylococcus aureus Supplemental Surveiallance Officer Survey	Form and Instruction	Modified	Available
Form 0920-0978 HAIC Invasive Staphylococcus aureus Annual Surveillance Officers Survey	Form and Instruction	Modified	Repair queued
Invasive Staph aureus Lab Survey	Form and Instruction	Modified	Available
HAIC Invasive Staphylococcus aureus Annual Laboratory Survey	Form and Instruction	Modified	Repair queued
Form 0920-0978 Emerging Infections Progrom C. difficile Surveillance Nuring Home Telephone Call Survey	Form and Instruction	Modified	Available
Form 0920-0978 HAIC CDI LTCF Survey	Form and Instruction	Modified	Repair queued
Form 0920-0978 Surveillance Officer's Survey	Form and Instruction	Modified	Repair queued
Form 0920-0978 HAIC CDI Annual Surveillance Officers Survey	Form and Instruction	Modified	Repair queued
Annual Survey of Laboratory Testing Practices for C. difficile Infection	Form and Instruction	Modified	Available
HAIC CDI Annual Laboratory Survey	Form and Instruction	Modified	Repair queued
FluSurv Lab Survey	Form	Modified	Available
Flu Surv NET Laboratory Survey	Form	Modified	Repair queued
FoodNET Lab Practices Volume	Form and Instruction	Modified	Available
Foodnet Clinical Laboratory Practices and Testing Volume	Form and Instruction	Modified	Repair queued
Candidemia Case Report	Form and Instruction	Modified	Available
HAIC Candidemia Case Report Form	Form and Instruction	Modified	Repair queued
MSSA Report 2021	Form and Instruction	Modified	Available
HAIC Invasive Methicillin-Sensitive Staphylococcus aureus (MSSA)	Form and Instruction	Modified	Repair queued
Form 0920-0978 2022 MuGSI Extended-Spectrum Beta-Lactamase (ESBL)-Producing Enterobacteriaceae Case Report Form	Form	Modified	Available
Form 0920-0978 HAIC Multi-Site Gram-Negative Surveillance Initiative - Extended Spectrum Beta-Lactamase Producing Enterobacteriaceae (MuGSI-ESBL)	Form	Modified	Repair queued
Form 0920-0978 FluSurv Net Provider Vaccination History Fax Form	Form and Instruction	Modified	Available
Form 0920-0978 Influenza Hospitalization Surveillance Project Provider Vaccination History Fax Form (Children/Adults)	Form and Instruction	Modified	Repair queued
Form 0920-0978 FluSurv NET Vaccination Phone Script	Form and Instruction	Modified	Available
Form 0920-0978 Influenza Hospitalization Surveillance Project Vaccination Telephone Script / Consent Form (Spanish)	Form and Instruction	Modified	Repair queued
Form 0920-0978 ABC Severe GAS Infection Supplemental Form	Form and Instruction	Modified	Repair queued
Form 0920-0978 ABCs Severe GAS Infection Supplemental Form	Form and Instruction	Modified	Repair queued
Form 0920-0978 ABC H. Influenzae Neonatal Sepsis Expanded Surveillance Form	Form and Instruction	Modified	Repair queued
Form 0920-0978 ABCs H. Influenzae Neonatal Sepsis Expanded Surveillance Form	Form and Instruction	Modified	Repair queued
Form 0920-0978 2022 Carbapenem Resistant Enterobacteriaceae (CRE)/ Carbapenem resistant A. baumannii (CRAB) MuGSI HAIC Case Report Form	Form	Modified	Available
Form 0920-0978 HAIC Multi-Site Gram-Negative Bacilli Case Report Form (MuGSI-CRE/CRAB)	Form	Modified	Repair queued
CDI Case Report	Form and Instruction	Modified	Available
HAIC CDI Case Report Form	Form and Instruction	Modified	Repair queued
Form 0920-0978 FluSurv NET Vaccination Phone Script	Form and Instruction	Modified	Available
Form 0920-0978 Influenza Hospitalization Surveillance Project Vaccination Telephone Script / Consent Form (English)	Form and Instruction	Modified	Repair queued
Form 0920-0978 FoodNet HUS CRF	Form and Instruction	Modified	Available
Form 0920-0978 FoodNet Hemolytic Uremic Syndrome (HUS)	Form and Instruction	Modified	Repair queued
Influenza Hospitalization Surveillance Network Case Report	Form and Instruction	Modified	Available
Influenza Hospitalization Surveilance Network Case Report Form	Form and Instruction	Modified	Repair queued
Neonatal Infection Expanded Tracking Form	Form and Instruction	Modified	Available
ABCs Neonatal Infection Expanded Tracking Form	Form and Instruction	Modified	Repair queued
Form 0920-0978 ABC Invasive Pneumococcal Disease in Children (age>2 months to <5 years	Form and Instruction	Modified	Available
Form 0920-0978 ABCs Invasive Pneumococcal Disease in Children	Form and Instruction	Modified	Repair queued
Invasive MRSA Case Report	Form and Instruction	Modified	Available
HAIC Invasive Methicillin-resistant Staphylococcus aureus (MRSA)	Form and Instruction	Modified	Repair queued
Form 0920-0978 2022 ABC Surveillance Case Report	Form and Instruction	Modified	Available
Form 0920-0978 ABCs Case Report Form	Form and Instruction	Modified	Repair queued
Att23- HAIC CA CP-CRE interview project manual.pdf	Supplementary Document	Uploaded 2022-04-25	Repair queued
EIP CDI ICMS PIA Signed 2.pdf	Supplementary Document	Uploaded 2022-04-25	Repair queued
MuGSI PIA Signed.pdf	Supplementary Document	Uploaded 2022-04-25	Repair queued
Att2- 60-Day FRN_2022.docx	Supplementary Document	Uploaded 2022-04-25	Repair queued
Att1- Authorizing_Regulations_T42_section_241.pdf	Supplementary Document	Uploaded 2022-04-25	Repair queued
SSB_EIP 2022 Revision_04052022.docx	Supporting Statement B	Uploaded 2022-04-25	Repair queued
SSA_EIP 2022 Revision_04212022_SMN_Clean final.docx	Supporting Statement A	Uploaded 2022-04-25	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
253051	HAIC Death Ascertainment Project	Form and Instruction	New	Death Ascertainment Project Variables
253051	HAIC Death Ascertainment Project	Form and Instruction	New
253049	HAIC Multi-site Gram-negative Surveillance Initiative (MuGSI) Supplemental Surveillance Officer Survey	Form and Instruction	New	MuGSI SO Survey Questionnaire
253049	HAIC Multi-site Gram-negative Surveillance Initiative (MuGSI) Supplemental Surveillance Officer Survey	Form and Instruction	New
253048	Community-Associated CP-CRE Interview	Form and Instruction	New	CA CP-CRE Survey Questionnaire
253048	Community-Associated CP-CRE Interview	Form and Instruction	New
235058	HAIC Candidemia Periodic Laboratory Survey	Form and Instruction	Modified	Candidemia Lab Survey
235058	HAIC Candidemia Periodic Laboratory Survey	Form and Instruction	Modified
235057	HAIC Invasive Staphylococcus aureus Annual Surveillance Officers Survey	Form and Instruction	Modified	2019 HAIC Invasive Staphylococcus aureus Supplemental Surveiallance Officer Survey
235057	HAIC Invasive Staphylococcus aureus Annual Surveillance Officers Survey	Form and Instruction	Modified
235056	HAIC Invasive Staphylococcus aureus Annual Laboratory Survey	Form and Instruction	Modified	Invasive Staph aureus Lab Survey
235056	HAIC Invasive Staphylococcus aureus Annual Laboratory Survey	Form and Instruction	Modified
235055	HAIC CDI LTCF Survey	Form and Instruction	Modified	Emerging Infections Progrom C. difficile Surveillance Nuring Home Telephone Call Survey
235055	HAIC CDI LTCF Survey	Form and Instruction	Modified
235054	HAIC CDI Annual Surveillance Officers Survey	Form and Instruction	Modified	Surveillance Officer's Survey
235054	HAIC CDI Annual Surveillance Officers Survey	Form and Instruction	Modified
235053	HAIC CDI Annual Laboratory Survey	Form and Instruction	Modified	Annual Survey of Laboratory Testing Practices for C. difficile Infection
235053	HAIC CDI Annual Laboratory Survey	Form and Instruction	Modified
235052	Flu Surv NET Laboratory Survey	Form	Modified	FluSurv Lab Survey
235052	Flu Surv NET Laboratory Survey	Form	Modified
235051	Foodnet Clinical Laboratory Practices and Testing Volume	Form and Instruction	Modified	FoodNET Lab Practices Volume
235051	Foodnet Clinical Laboratory Practices and Testing Volume	Form and Instruction	Modified
231114	HAIC Candidemia Case Report Form	Form and Instruction	Modified	Candidemia Case Report
231114	HAIC Candidemia Case Report Form	Form and Instruction	Modified
231113	HAIC Invasive Methicillin-Sensitive Staphylococcus aureus (MSSA)	Form and Instruction	Modified	MSSA Report 2021
231113	HAIC Invasive Methicillin-Sensitive Staphylococcus aureus (MSSA)	Form and Instruction	Modified
231112	HAIC Multi-Site Gram-Negative Surveillance Initiative - Extended Spectrum Beta-Lactamase Producing Enterobacteriaceae (MuGSI-ESBL)	Form	Modified	2022 MuGSI Extended-Spectrum Beta-Lactamase (ESBL)-Producing Enterobacteriaceae Case Report Form
231112	HAIC Multi-Site Gram-Negative Surveillance Initiative - Extended Spectrum Beta-Lactamase Producing Enterobacteriaceae (MuGSI-ESBL)	Form	Modified
231111	Influenza Hospitalization Surveillance Project Provider Vaccination History Fax Form (Children/Adults)	Form and Instruction	Modified	FluSurv Net Provider Vaccination History Fax Form
231111	Influenza Hospitalization Surveillance Project Provider Vaccination History Fax Form (Children/Adults)	Form and Instruction	Modified
231110	Influenza Hospitalization Surveillance Project Vaccination Telephone Script / Consent Form (Spanish)	Form and Instruction	Modified	FluSurv NET Vaccination Phone Script
231110	Influenza Hospitalization Surveillance Project Vaccination Telephone Script / Consent Form (Spanish)	Form and Instruction	Modified
230869	ABCs Severe GAS Infection Supplemental Form	Form and Instruction	Modified	ABC Severe GAS Infection Supplemental Form
230869	ABCs Severe GAS Infection Supplemental Form	Form and Instruction	Modified
220380	ABCs H. Influenzae Neonatal Sepsis Expanded Surveillance Form	Form and Instruction	Modified	ABC H. Influenzae Neonatal Sepsis Expanded Surveillance Form
220380	ABCs H. Influenzae Neonatal Sepsis Expanded Surveillance Form	Form and Instruction	Modified
217336	HAIC Multi-Site Gram-Negative Bacilli Case Report Form (MuGSI-CRE/CRAB)	Form	Modified	2022 Carbapenem Resistant Enterobacteriaceae (CRE)/ Carbapenem resistant A. baumannii (CRAB) MuGSI HAIC Case Report Form
217336	HAIC Multi-Site Gram-Negative Bacilli Case Report Form (MuGSI-CRE/CRAB)	Form	Modified
217334	HAIC CDI Case Report Form	Form and Instruction	Modified	CDI Case Report
217334	HAIC CDI Case Report Form	Form and Instruction	Modified
207663	FoodNet Yersinia	Other-Variable list	Modified
207662	FoodNet Vibrio	Other-Variable list	Modified
207661	FoodNet Shigella	Other-Variable list	Modified
207660	FoodNet Shiga toxin producing E. coli	Other-Variable list	Modified
207659	FoodNet Salmonella	Other-Variable list	Modified
207658	FoodNet Listeria monocytogenes	Other-Variable list	Modified
207657	FoodNet Cyclospora	Other-Variable list	Modified
207655	FoodNet Campylobacter	Other-Variable list	Modified
207653	Influenza Hospitalization Surveillance Project Vaccination Telephone Script / Consent Form (English)	Form and Instruction	Modified	FluSurv NET Vaccination Phone Script
207653	Influenza Hospitalization Surveillance Project Vaccination Telephone Script / Consent Form (English)	Form and Instruction	Modified
207652	FoodNet Hemolytic Uremic Syndrome (HUS)	Form and Instruction	Modified	FoodNet HUS CRF
207652	FoodNet Hemolytic Uremic Syndrome (HUS)	Form and Instruction	Modified
207651	Influenza Hospitalization Surveilance Network Case Report Form	Form and Instruction	Modified	Influenza Hospitalization Surveillance Network Case Report
207651	Influenza Hospitalization Surveilance Network Case Report Form	Form and Instruction	Modified
207649	ABCs Neonatal Infection Expanded Tracking Form	Form and Instruction	Modified	Neonatal Infection Expanded Tracking Form
207649	ABCs Neonatal Infection Expanded Tracking Form	Form and Instruction	Modified
207648	ABCs Invasive Pneumococcal Disease in Children	Form and Instruction	Modified	ABC Invasive Pneumococcal Disease in Children (age>2 months to <5 years
207648	ABCs Invasive Pneumococcal Disease in Children	Form and Instruction	Modified
207647	HAIC Invasive Methicillin-resistant Staphylococcus aureus (MRSA)	Form and Instruction	Modified	Invasive MRSA Case Report
207647	HAIC Invasive Methicillin-resistant Staphylococcus aureus (MRSA)	Form and Instruction	Modified
207646	ABCs Case Report Form	Form and Instruction	Modified	2022 ABC Surveillance Case Report
207646	ABCs Case Report Form	Form and Instruction	Modified

ICR Details

OMB Control No: 0920-0978	ICR Reference No: 202204-0920-008
Status: Historical Active	Previous ICR Reference No: 202112-0920-010
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-0978
Title: Emerging Infections Program
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/08/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 04/25/2022
Terms of Clearance: Approval is consistent with the understanding that CDC will continue to add (and keep current) language on each program's website and in their reports that clearly caveats the interpretation of longitudinal trends due to temporal changes in methods, definitions, geographic coverage (for example, changes in the number and characteristics of participating hospitals).

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2026	36 Months From Approved	02/28/2023
Responses	132,520	0	99,360
Time Burden (Hours)	53,784	0	38,810
Cost Burden (Dollars)	0	0	0

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Abstract: The Emerging Infections Programs (EIP) is to 1) detect and monitor emerging pathogens, the diseases they cause, and the factors influencing their emergence, and respond to problems as they are identified, 2) integrate laboratory science and epidemiology to optimize public health practice, 3) strengthen infrastructure to support surveillance and research and to implement prevention and control programs, and to 4) ensure implementation of prevention strategies and communication of public health information about emerging diseases. Surveillance efforts of the core EIP activities generate reliable estimates of the incidence of certain infections and provide the foundation for a variety of epidemiologic studies. This Revision requests the use of two additional forms and including minor revised language and rewording to improve clarity and readability of the data collection forms. Programs covered by this ICR include: Active Bacterial Core surveillance (ABCs): active population-based laboratory surveillance for invasive bacterial diseases; Foodborne Diseases Active Surveillance Network (FoodNet): active population-based laboratory surveillance to monitor the incidence of select enteric diseases; Influenza: active population-based surveillance for laboratory confirmed influenza-related hospitalizations; and Healthcare Associated Infections-Community Interface (HAIC): active population-based surveillance for healthcare associated pathogens and infections (including Clostridium difficile infection).

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Authorizing Statute(s): US Code: 42 USC 301 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 4891	01/31/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 24305	04/25/2022
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 35

table that charts list of burden

IC Title	Form No.	Form Name
ABCs Case Report Form	0920-0978	2022 ABC Surveillance Case Report
ABCs H. Influenzae Neonatal Sepsis Expanded Surveillance Form	0920-0978	ABC H. Influenzae Neonatal Sepsis Expanded Surveillance Form
ABCs Invasive Pneumococcal Disease in Children	0920-0978	ABC Invasive Pneumococcal Disease in Children (age>2 months to <5 years
ABCs Neonatal Infection Expanded Tracking Form	none	Neonatal Infection Expanded Tracking Form
ABCs Severe GAS Infection Supplemental Form	0920-0978	ABC Severe GAS Infection Supplemental Form
Community-Associated CP-CRE Interview	0920-0978	CA CP-CRE Survey Questionnaire
Flu Surv NET Laboratory Survey	none	FluSurv Lab Survey
FoodNet Campylobacter
FoodNet Cyclospora
FoodNet Hemolytic Uremic Syndrome (HUS)	0920-0978	FoodNet HUS CRF
FoodNet Listeria monocytogenes
FoodNet Salmonella
FoodNet Shiga toxin producing E. coli
FoodNet Shigella
FoodNet Vibrio
FoodNet Yersinia
Foodnet Clinical Laboratory Practices and Testing Volume	none	FoodNET Lab Practices Volume
HAIC CDI Annual Laboratory Survey	n/a	Annual Survey of Laboratory Testing Practices for C. difficile Infection
HAIC CDI Annual Surveillance Officers Survey	0920-0978	Surveillance Officer's Survey
HAIC CDI Case Report Form	none	CDI Case Report
HAIC CDI LTCF Survey	0920-0978	Emerging Infections Progrom C. difficile Surveillance Nuring Home Telephone Call Survey
HAIC Candidemia Case Report Form	none	Candidemia Case Report
HAIC Candidemia Periodic Laboratory Survey	none	Candidemia Lab Survey
HAIC Death Ascertainment Project	0920-0978	Death Ascertainment Project Variables
HAIC Invasive Methicillin-Sensitive Staphylococcus aureus (MSSA)	none	MSSA Report 2021
HAIC Invasive Methicillin-resistant Staphylococcus aureus (MRSA)	none	Invasive MRSA Case Report
HAIC Invasive Staphylococcus aureus Annual Laboratory Survey	none	Invasive Staph aureus Lab Survey
HAIC Invasive Staphylococcus aureus Annual Surveillance Officers Survey	0920-0978	2019 HAIC Invasive Staphylococcus aureus Supplemental Surveiallance Officer Survey
HAIC Multi-Site Gram-Negative Bacilli Case Report Form (MuGSI-CRE/CRAB)	0920-0978	2022 Carbapenem Resistant Enterobacteriaceae (CRE)/ Carbapenem resistant A. baumannii (CRAB) MuGSI HAIC Case Report Form
HAIC Multi-Site Gram-Negative Surveillance Initiative - Extended Spectrum Beta-Lactamase Producing Enterobacteriaceae (MuGSI-ESBL)	0920-0978	2022 MuGSI Extended-Spectrum Beta-Lactamase (ESBL)-Producing Enterobacteriaceae Case Report Form
HAIC Multi-site Gram-negative Surveillance Initiative (MuGSI) Supplemental Surveillance Officer Survey	0920-0978	MuGSI SO Survey Questionnaire
Influenza Hospitalization Surveilance Network Case Report Form	none	Influenza Hospitalization Surveillance Network Case Report
Influenza Hospitalization Surveillance Project Provider Vaccination History Fax Form (Children/Adults)	0920-0978	FluSurv Net Provider Vaccination History Fax Form
Influenza Hospitalization Surveillance Project Vaccination Telephone Script / Consent Form (English)	0920-0978	FluSurv NET Vaccination Phone Script
Influenza Hospitalization Surveillance Project Vaccination Telephone Script / Consent Form (Spanish)	0920-0978	FluSurv NET Vaccination Phone Script

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ICR Summary of Burden

table that charts list of burden

	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	132,520	99,360	0	33,160	0	0
Annual Time Burden (Hours)	53,784	38,810	0	14,974	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Three new forms were added and a couple minor adjustments/corrections to burden or respondents.

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Annual Cost to Federal Government: $36,032,895

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 04/25/2022

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