Form I5 C. Auris Colonization Screening in Jurisdiction

Form Approved

OMB Control No.: 0920-1310

Expiration date: XX/XX/XXXX

Annual Evaluation and Performance Measurement Report (I.5- C. AURIS COLONIZATION SCREENING 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. Total number of specimens (colonization screening swabs) tested

2. Total number of colonization screening swabs positive for C. auris

3. Median number and range from specimen receipt at public health laboratory to communication of test result

a. Median (in days)

b. Range (in days)

4. Describe any challenges with reporting colonization testing results back to submitter within required timeframe.

5. Describe challenges or barriers to testing all swabs.

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