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

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⚠️ Notice: This information collection may be referencing outdated material.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

Information Collection (IC) Details

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:

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 %

	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

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.