Information Collection

HAIC Invasive Staphylococcus aureus Infection Case Report Form

IC 207647 under ICR 202309-0920-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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 CDC 52.15B HAIC Invasive Staphylococcus aureus Infection Case Report Form	Form
CDC 52.15B Invasive Staphylococcus aureus Healthcare-Associated Inf Att12_HAIC_iSA2024.pdf	Form
CDC 52.15B Invasive Staphylococcus aureus Healthcare-Associated Inf Att12_HAIC_iSA2024.pdf	Form

IC Title:

HAIC Invasive Staphylococcus aureus Infection Case Report Form

Agency IC Tracking Number:

0920-0978-23HY

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 301 Public Health Service Act

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	CDC 52.15B	Invasive Staphylococcus aureus Healthcare-Associated Infections Community Interface (HAIC) Case Report â 2024	Att12_HAIC_iSA2024.pdf		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
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	7,800	4,400	3,400
Annual IC Time Burden (Hours)	3,640	2,053	1,587
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.