2024 (MuGSI) Healthcare-Associated Infections Community Interface (HAIC) Case Report

[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⚠️ Notice: This information collection may be referencing outdated material.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 HAIC.400.1 2024 (MuGSI) Healthcare-Associated Infections Community Interface (HAIC) Case Report Form
HAIC.400.1 2024 Multi-site Gram-Negative Surveillance Initiative (M HAIC.400.1 HAIC Multi-site Gram-Negative Surveillance Initiative_MuGSI_Case Report Form.pdf Form
HAIC.400.1 2024 Multi-site Gram-Negative Surveillance Initiative (M HAIC.400.1 HAIC Multi-site Gram-Negative Surveillance Initiative_MuGSI_Case Report Form.pdf Form

Information Collection (IC) Details

IC Title:	2024 (MuGSI) Healthcare-Associated Infections Community Interface (HAIC) Case Report	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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	HAIC.400.1	2024 Multi-site Gram-Negative Surveillance Initiative (MuGSI) Healthcare-Associated Infections Community Interface (HAIC) Case Report	HAIC.400.1 HAIC Multi-site Gram-Negative Surveillance Initiative_MuGSI_Case Report Form.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: 11	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	Previously Approved
Annual Number of Responses for this IC	17,391	-29,609	47,000
Annual IC Time Burden (Hours)	8,406	-13,527	21,933
Annual IC Cost Burden (Dollars)	0	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.