Form I1 Routine Testing by Genus in Jurisdiction

Form Approved OMB Control No.: 0920-1310 Expiration date: XX/XX/XXXX

Annual Evaluation and Performance Measurement Report (I.1 – ROUTINE TESTING BY GENUS IN JURISDICTION)

Annually, each funded laboratory is required to report to CDC evaluation and performance measures. Data are used to indicate progress made toward program outcomes. These summary reports have to be uploaded to the ELC CAMP at the end of each funding year. Required performance measures are listed below.

1. Do you test all isolates received?

• Yes

• No

1. If no, describe any challenges or barriers to testing all isolates

2. Proportion of isolates tested in accordance to CDC protocols:

1. Numerator: Total number of isolates tested

2. Denominator: Total number of isolates received

3. Calculated: Percent of isolates tested

3. Number of isolates tested by genus (if Candida, then by species) (for regional laboratories, please also include the state of origin):

Genera/Species Name	Number of Isolates Submitted	If applicable: State of Origin

4. For regional laboratories only: include number of isolates forwarded by state/local AR Lab Network laboratories to regional laboratory for testing.

Name of Submitting State	Number of Isolates Sent

Public reporting burden of this collection of information is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.  An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB Control Number.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NE, MS H21-8, Atlanta, Georgia 30333; ATTN: PRA 0920-1310