Information Collection

HAIC - CDI Case Report and Treatment Form

IC 217334 under ICR 202312-0920-011 · 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⚠️ Notice: This information collection may be referencing outdated material.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 CS 342179-A 8/3/20 HAIC - CDI Case Report and Treatment Form	Form and Instruction
Form CS 342179-A 8/3/20 HAIC - CDI Case Report and Treatment Form	Form and Instruction
CS 342179-A 8/3/20 CLOSTRIDIOIDES DIFFICILE INFECTION (CDI) SURVEILLANCE EM Att11_HAIC_2024 CDI CRF - changes highlighted.pdf	Form and Instruction
CS 342179-A 8/3/20 CLOSTRIDIOIDES DIFFICILE INFECTION (CDI) SURVEILLANCE EM Att11_HAIC_2024 CDI CRF - changes highlighted.pdf	Form and Instruction

IC Title:

HAIC - CDI Case Report and Treatment Form

Agency IC Tracking Number:

0920-0978-24BX

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 301 PHSA

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	CS 342179-A 8/3/2023	CLOSTRIDIOIDES DIFFICILE INFECTION (CDI) SURVEILLANCE EMERGING INFECTIONS PROGRAM CASE REPORT	Att11_HAIC_2024 CDI CRF - changes highlighted.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
	Approved	Previously Approved
Annual Number of Responses for this IC	16,500	16,500
Annual IC Time Burden (Hours)	10,450	10,450
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.