Information Collection

HAIC MuGSI CA CP-CRE Health interview

IC 253048 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⚠️ Notice: This information collection may be referencing outdated material.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 MuGSI CA CP-CRE Health interview	Form and Instruction
Form 0920-0978 HAIC MuGSI CA CP-CRE Health interview	Form and Instruction
0920-0978 Community-Associated CP-CRE Interview Att9_HAIC_CA_CP_CRE_interviews_ questionnaire v 20_05252021.pdf	Form and Instruction
0920-0978 Community-Associated CP-CRE Interview Att9_HAIC_CA_CP_CRE_interviews_ questionnaire v 20_05252021.pdf	Form and Instruction

IC Title:

HAIC MuGSI CA CP-CRE Health interview

Agency IC Tracking Number:

0920-0978-24BX

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	0920-0978	Community-Associated CP-CRE Interview	Att9_HAIC_CA_CP_CRE_interviews_ questionnaire v 20_05252021.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
	Approved	Previously Approved
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	50	50
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.