Information Collection

VIM-Carbapenem Resistant Pseudomonas aeruginosa (VIM-CRPA) Outbreak Investigation Abstraction Form

IC 257566 under ICR 202209-0920-030 · OMB 0920-1011.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1011 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1011 VIM-Carbapenem Resistant Pseudomonas aeruginosa (VIM-CRPA) Outbreak Investigation Abstraction Form	Form
0920-1011 Chart Abstraction Form Appendix 1_VIM_CRPA_chart_abstraction_final.docx	Form
0920-1011 Facility Product List Appendix 2_ Facility_product_list_VIM-CRPA.xlsx	Form
CSTE letter of support_PseudomonasAeruginosa2022.pdf CSTE Letter of Support/Invitation	IC Document
0920-1011 GenIC Burden Memo.msg 0920-1011 Burden Memo	IC Document
2023001-XXX VIM-CRPA_multistate.docx 0929-1011 GenIC Request Memo	IC Document

IC Title:

VIM-Carbapenem Resistant Pseudomonas aeruginosa (VIM-CRPA) Outbreak Investigation Abstraction Form

Agency IC Tracking Number:

0920-1011-23BT

IC Status: New

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	0920-1011	Chart Abstraction Form	Appendix 1_VIM_CRPA_chart_abstraction_final.docx	NA	Yes	Yes	Fillable Fileable
Form	0920-1011	Facility Product List	Appendix 2_ Facility_product_list_VIM-CRPA.xlsx	NA	Yes	Yes	Fillable Fileable

Line of Business: Disaster Management

Subfunction: Emergency Response

Privacy Act System of Records

Title: Epidemic Investigation Case Records - SORN number 09-20-0113

FR Citation: 51 FR 42466

Number of Respondents: 30

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	105	105
Annual IC Time Burden (Hours)	105	105
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CSTE Letter of Support/Invitation	CSTE letter of support_PseudomonasAeruginosa2022.pdf	12/22/2022
0920-1011 Burden Memo	0920-1011 GenIC Burden Memo.msg	12/22/2022
0929-1011 GenIC Request Memo	2023001-XXX VIM-CRPA_multistate.docx	12/22/2022

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.