Emerging Infections Program C. difficile Surveillance Nursing Home Telephone Survey

[NCEZID] Emerging Infections Program

Documents and Forms

Document Name Document Type
Form HAIC.400.10 Emerging Infections Program C. difficile Surveillance Nursing Home Telephone Survey Form and Instruction
Form HAIC.400.10 Emerging Infections Program C. difficile Surveillance Nursing Home Telephone Survey Form and Instruction
HAIC.400.10 Emerging Infections Program C. difficile Surveillance Nu HAIC.400.10 HAIC C. difficile Surveillance Nursing Home Telephone Survey.pdf Form and Instruction
HAIC.400.10 Emerging Infections Program C. difficile Surveillance Nu HAIC.400.10 HAIC C. difficile Surveillance Nursing Home Telephone Survey.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Emerging Infections Program C. difficile Surveillance Nursing Home Telephone Survey	Agency IC Tracking Number:	0920-0978

Is this a Common Form? No		IC Status: Unchanged

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 and Instruction	HAIC.400.10	Emerging Infections Program C. difficile Surveillance Nursing Home Telephone Survey	HAIC.400.10 HAIC C. difficile Surveillance Nursing Home Telephone Survey.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: 10	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	450	450
Annual IC Time Burden (Hours)	38	38
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.