Information Collection

HAIC (MuGSI) Supplemental Surveillance Officer Survey

IC 253049 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⚠️ Notice: This information collection may be referencing outdated material.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 C5342262-A HAIC (MuGSI) Supplemental Surveillance Officer Survey	Form and Instruction
C5342262-A 2024 Multi-site Gram-Negative Surveillance Initiative (M Att11_HAIC_FINAL - 2024 MuGSI SO Survey_081023.pdf	Form and Instruction
C5342262-A 2024 Multi-site Gram-Negative Surveillance Initiative (M Att11_HAIC_FINAL - 2024 MuGSI SO Survey_081023.pdf	Form and Instruction

IC Title:

HAIC (MuGSI) Supplemental Surveillance Officer Survey

Agency IC Tracking Number:

0920-0978-23HY

Is this a Common Form? No

IC Status: Modified

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	C5342262-A	2024 Multi-site Gram-Negative Surveillance Initiative (MuGSI) Healthcare-Associated Infections Community Interface (HAIC) Case Report	Att11_HAIC_FINAL - 2024 MuGSI SO Survey_081023.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

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	Previously Approved
Annual Number of Responses for this IC	10	10
Annual IC Time Burden (Hours)	3	3
Annual IC Cost Burden (Dollars)	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.