Information Collection

HAIC Multi-Site Gram-Negative Surveillance Initiative - Extended Spectrum Beta-Lactamase Producing Enterobacteriaceae (MuGSI-ESBL)

IC 231112 under ICR 202204-0920-008 · 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⚠️ Notice: This information collection may be referencing outdated material.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 0920-0978 HAIC Multi-Site Gram-Negative Surveillance Initiative - Extended Spectrum Beta-Lactamase Producing Enterobacteriaceae (MuGSI-ESBL)	Form
0920-0978 2022 MuGSI Extended-Spectrum Beta-Lactamase (ESBL)-Produ Att21- HAIC MuGSI ESBL_iEC_2023_3.21.2022.pdf	Form
0920-0978 2022 MuGSI Extended-Spectrum Beta-Lactamase (ESBL)-Produ Att21- HAIC MuGSI ESBL_iEC_2023_3.21.2022.pdf	Form

IC Title:

HAIC Multi-Site Gram-Negative Surveillance Initiative - Extended Spectrum Beta-Lactamase Producing Enterobacteriaceae (MuGSI-ESBL)

Agency IC Tracking Number:

0920-0978

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 301 PHSA

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	0920-0978	2022 MuGSI Extended-Spectrum Beta-Lactamase (ESBL)-Producing Enterobacteriaceae Case Report Form	Att21- HAIC MuGSI ESBL_iEC_2023_3.21.2022.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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	42,000	30,960	11,040
Annual IC Time Burden (Hours)	17,500	12,348	5,152
Annual IC Cost Burden (Dollars)	0	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.