Candida auris Case Report Form

[NCEZID] Characteristics of Cases of Priority Fungal Diseases

Documents and Forms

Document Name Document Type
Candida auris Case Report Form Form and Instruction
Candida auris Case Report Form Att 3e-Candida auris Case Report Form.docx Form and Instruction
Candida auris Case Report Form Att 3e-Candida auris Case Report Form.docx Form and Instruction
Candida auris Case Report Form rev Att 3e-Candida auris Case Report Form.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Candida auris Case Report Form	Agency IC Tracking Number:	0920-1385

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	n/a	Candida auris Case Report Form	Att 3e-Candida auris Case Report Form.docx		Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Candida auris Case Report Form rev	Att 3e-Candida auris Case Report Form.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 15	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	225	225
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.