Information Collection

HAIC- EIP C. difficile Surveillance Nursing Home Telephone Survey (LTCF)

IC 235055 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⚠️ Notice: This information collection may be referencing outdated material.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 0920-0978 HAIC- EIP C. difficile Surveillance Nursing Home Telephone Survey (LTCF)	Form and Instruction
Form 0920-0978 HAIC- EIP C. difficile Surveillance Nursing Home Telephone Survey (LTCF)	Form and Instruction
0920-0978 Emerging Infections Progrom C. difficile Surveillance Nu Att19- HAIC CDI Call Script for LTCF Survey.pdf	Form and Instruction
0920-0978 Emerging Infections Progrom C. difficile Surveillance Nu Att19- HAIC CDI Call Script for LTCF Survey.pdf	Form and Instruction

IC Title:

HAIC- EIP C. difficile Surveillance Nursing Home Telephone Survey (LTCF)

Agency IC Tracking Number:

0920-0978

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	0920-0978	Emerging Infections Progrom C. difficile Surveillance Nuring Home Telephone Call Survey	Att19- HAIC CDI Call Script for LTCF Survey.pdf	NA	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	450	450
Annual IC Time Burden (Hours)	38	38
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.