HAIC - CDI Case Report and Treatment Form

[NCEZID] Emerging Infections Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0978 can be found here:

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.