Information Collection

Post-product recall investigation of a multistate cluster of VIM-producing carbapenem resistant Pseudomonas aeruginosa associated with artificial tear use

IC 259529 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⚠️ Notice: This information collection may be referencing outdated material.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:

2025-11-21 - Extension without change of a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1011 VIM-CRPA Outbreak Chart Abstraction Form] Post-product recall investigation of a multistate cluster of VIM-producing carbapenem resistant Pseudomonas aeruginosa associated with artificial tear use	Form and Instruction
0920-1011 VIM-CRPA Outbreak Chart Abstraction Form] Appendix 1 Chart abstraction form.docx	Form and Instruction
Burden Estimate_EEI Generic ICR VIMCRPA 040623.docx Memo - 0920-1011 GenIC Burden Estimate	IC Document
CSTE Letter of Support Pseudomonas Aeruginosa 2023_update 03312023.pdf Letter of Invitation (CSTE)	IC Document
1. GenIC Request Form - EEI Generic ICR VIM_CRPA 040623.docx Emergency Epidemic Investigation (EEI) GenIC Request Memo	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Post-product recall investigation of a multistate cluster of VIM-producing carbapenem resistant Pseudomonas aeruginosa associated with artificial tear use

Agency IC Tracking Number:

0920-1011-23DX

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 and Instruction	0920-1011			NA	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

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: 15

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	60	60
Annual IC Time Burden (Hours)	45	45
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Memo - 0920-1011 GenIC Burden Estimate		04/06/2023
Letter of Invitation (CSTE)		04/06/2023
Emergency Epidemic Investigation (EEI) GenIC Request Memo		04/06/2023

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

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