Information Collection

Invasive Staphylococcus aureus Healthcare-Associated Infections Community Interface (HAIC) Case Report

IC 231113 under ICR 202410-0920-009 · OMB 0920-0978.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0978 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form HAIC.400.4 Invasive Staphylococcus aureus Healthcare-Associated Infections Community Interface (HAIC) Case Report	Form and Instruction
Form HAIC.400.4 Invasive Staphylococcus aureus Healthcare-Associated Infections Community Interface (HAIC) Case Report	Form and Instruction
HAIC.400.4 Invasive Staphylococcus aureus Healthcare-Associated Inf HAIC.400.4 HAIC Invasive Staphylococcus aureus Infection Case Report Form.pdf	Form and Instruction
HAIC.400.4 Invasive Staphylococcus aureus Healthcare-Associated Inf HAIC.400.4 HAIC Invasive Staphylococcus aureus Infection Case Report Form.pdf	Form and Instruction
HAIC 400.4 Invasive Staphylococcus aureus Healthcare-Associated Inf HAIC.400.4 iSA2025_CRF.pdf	Form and Instruction
HAIC 400.4 Invasive Staphylococcus aureus Healthcare-Associated Inf HAIC.400.4 iSA2025_CRF.pdf	Form and Instruction

IC Title:

Invasive Staphylococcus aureus 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:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	HAIC.400.4	Invasive Staphylococcus aureus Healthcare-Associated Infections Community Interface (HAIC) Case Report â 2024	HAIC.400.4 HAIC Invasive Staphylococcus aureus Infection Case Report Form.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	HAIC 400.4	Invasive Staphylococcus aureus Healthcare-Associated Infections Community Interface (HAIC) Case Report	HAIC.400.4 iSA2025_CRF.pdf	N/A	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	7,880	7,880
Annual IC Time Burden (Hours)	3,809	3,809
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.