[NCEZID] Characteristics of Cases of Priority Fungal Diseases

ICR 202402-0920-008

OMB: 0920-1385

Federal Form Document

Forms and Documents

Document Name	Status
Antifungal-resistant dermatophytosis case report form Form and Instruction	New
Candida auris Case Report Form Form and Instruction	New
Blastomycosis Case Report Form Form and Instruction	New
Histoplasmosis Case Report Form Form and Instruction	New
Coccidioidomycosis Case Report Form Form and Instruction	New
Triazole-resistant Aspergillus fumigatus Case Report Form Form and Instruction	Modified
Att. 5- Privacy Impact Assessment.pdf Supplementary Document	2024-03-14
Att 4- Human Subjects Determination.pdf Supplementary Document	2024-03-14
Att 2-Published 60-day FRN.pdf Supplementary Document	2024-03-14
Att 1 Section 301 of the Public Health Service Act (42 USC 241).pdf Supplementary Document	2024-03-14
Supporting Statement B.docx Supporting Statement B	2024-03-14
Supporting Statement A_final.docx Supporting Statement A	2024-03-14

IC Document Collections

IC ID	Document Title	Status
266002	Antifungal-resistant dermatophytosis case report form Form and Instruction	New
266001	Candida auris Case Report Form Form and Instruction	New
266000	Blastomycosis Case Report Form Form and Instruction	New
265999	Histoplasmosis Case Report Form Form and Instruction	New
265998	Coccidioidomycosis Case Report Form Form and Instruction	New
254011	Triazole-resistant Aspergillus fumigatus Case Report Form Form and Instruction	Modified