[NCEZID] Emerging Infections Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form HAIC.400.14 HAIC MuGSI KPC and NDM treatment collection form	Form and Instruction	New	Repair queued
Form HAIC.400.14 HAIC MuGSI KPC and NDM Treatment Collection Form	Form and Instruction	New	Missing upstream
Form HAIC.400.13 Data Elements Transferred to CDC for the HAIC Death Ascertainment Project	Form and Instruction	Modified	Available
Form HAIC.400.13 Data Elements Transferred to CDC for the HAIC Death Ascertainment Project	Form and Instruction	Modified	Repair queued
Form HAIC.400.3 HAIC Multi-site Gram-negative Surveillance Initiative (MuGSI) Supplemental Surveillance Officer Survey	Form and Instruction	Modified	Available
Form HAIC.400.3 HAIC Multi-site Gram-negative Surveillance Initiative (MuGSI) Supplemental Surveillance Officer Survey	Form and Instruction	Modified	Repair queued
Form HAIC.400.2 Community-Associated CP-CRE Interview	Form and Instruction	Modified	Available
Form HAIC.400.2 Community-Associated CP-CRE Interview	Form and Instruction	Modified	Repair queued
Form HAIC.400.12 LABORATORY TESTING PRACTICES FOR CANDIDEMIA QUESTIONNAIRE	Form and Instruction	Modified	Available
Form HAIC.400.12 HAIC_LABORATORY TESTING PRACTICES FOR CANDIDEMIA QUESTIONNAIRE	Form and Instruction	Modified	Repair queued
Form HAIC.400.6 HAIC Invasive Staphylococcus aureus Supplemental Surveillance Officer Survey	Form and Instruction	Modified	Available
Form HAIC.400.6 HAIC Invasive Staphylococcus aureus Supplemental Surveillance Officer Survey	Form and Instruction	Modified	Repair queued
Form HAIC.400.5 CDC’s Healthcare-Associated Infections Community Interface (HAIC) Staphylococcus aureus Laboratory Survey	Form and Instruction	Modified	Available
Form HAIC.400.5 CDC's Healthcare-Associated Infections Community Interface (HAIC) Staphylococcus aureus Laboratory Survey	Form and Instruction	Modified	Repair queued
Form HAIC.400.10 Emerging Infections Program C. difficile Surveillance Nursing Home Telephone Survey	Form and Instruction	Modified	Repair queued
Form HAIC.400.10 Emerging Infections Program C. difficile Surveillance Nursing Home Telephone Survey	Form and Instruction	Modified	Repair queued
Form HAIC.400.9 HAIC Surveillance Officer’s Survey	Form and Instruction	Modified	Available
Form HAIC.400.9 HAIC-Surveillance Officer's Survey	Form and Instruction	Modified	Repair queued
Form HAIC.400.8 Annual Survey of Laboratory Testing Practices for C. difficile Infection	Form and Instruction	Modified	Available
Form HAIC.400.8 Annual Survey of Laboratory Testing Practices for C. difficile Infection	Form and Instruction	Modified	Repair queued
Form FSN.300.4 FluSurv-NET Laboratory Survey	Form	Modified	Repair queued
Form FSN.300.4 FluSurv-NET Laboratory Survey	Form	Modified	Repair queued
Form FN.200.10 FoodNET Lab Survey Variable List	Form	Modified	Available
Form FN.200.10 FoodNET Lab Survey Variable List	Form	Modified	Missing upstream
Form HAIC.400.11 CANDIDEMIA CASE REPORT FORM	Form and Instruction	Modified	Available
Form HAIC.400.11 CANDIDEMIA CASE REPORT FORM	Form and Instruction	Modified	Missing upstream
Form HAIC.400.4 Invasive Staphylococcus aureus Healthcare-Associated Infections Community Interface (HAIC) Case Report	Form and Instruction	Modified	Repair queued
Form HAIC.400.4 Invasive Staphylococcus aureus Healthcare-Associated Infections Community Interface (HAIC) Case Report	Form and Instruction	Modified	Repair queued
Form FSN.300.3 FLUSURV-NET: PROVIDER PEDIATRIC VACCINATION HISTORY REQUEST LETTER/FORM	Form and Instruction	Modified	Available
Form FSN.300.3 FLUSURV-NET: PROVIDER PEDIATRIC VACCINATION HISTORY REQUEST LETTER/FORM	Form and Instruction	Modified	Missing upstream
Form ABC.100.4 ABCs Severe GAS Infection: Supplemental Form	Form and Instruction	Removed	Available
Form ABC.100.4 ABCs Severe GAS Infection: Supplemental Form	Form and Instruction	Removed	Repair queued
Form ABC.100.3 2019 ABC H. Influenzae Neonatal Sepsis Expanded Surveillance Form	Form and Instruction	Removed	Available
Form ABC.100.3 2019 ABCs H. Influenzae Neonatal Sepsis Expanded Surveillance Form	Form and Instruction	Removed	Missing upstream
Form HAIC.400.1 Multi-site Gram-Negative Surveillance Initiative (MuGSI) Healthcare-Associated Infections Community Interface (HAIC) Case Report	Form and Instruction	Modified	Repair queued
Form HAIC.400.1 (MuGSI) Healthcare-Associated Infections Community Interface (HAIC) Case Report	Form and Instruction	Modified	Repair queued
Form HAIC.400.7 CLOSTRIDIOIDES DIFFICILE INFECTION (CDI) SURVEILLANCE EMERGING INFECTIONS PROGRAM CASE REPORT	Form and Instruction	Modified	Available
Form HAIC.400.7 CLOSTRIDIOIDES DIFFICILE INFECTION (CDI) SURVEILLANCE EMERGING INFECTIONS PROGRAM CASE REPORT	Form and Instruction	Modified	Missing upstream
Form FN.200.8 FoodNet Variable List_ (YERSINIA)	Form and Instruction	Modified	Available
Form FN.200.8 FoodNet Variable List_ (YERSINIA)	Form and Instruction	Modified	Repair queued
Form FN.200.7 FoodNet Variable List_ (VIBRIO)	Form and Instruction	Modified	Available
Form FN.200.7 FoodNet Variable List_ (VIBRIO)	Form and Instruction	Modified	Missing upstream
Form FN.200.6 FoodNet Variable List_ (SHIGELLA)	Form and Instruction	Modified	Available
Form FN.200.6 FoodNet Variable List_ (SHIGELLA)	Form and Instruction	Modified	Available
Form FN.200.5 FoodNet Variable List_ (SHIGA TOXIN PRODUCING E.COLI)	Form and Instruction	Modified	Available
Form FN.200.5 FoodNet Variable List_ (SHIGA TOXIN PRODUCING E.COLI)	Form and Instruction	Modified	Missing upstream
Form FN.200.4 FoodNet Variable List_ (SALMONELLA)	Form and Instruction	Modified	Available
Form FN.200.4 FoodNet Variable List_ (SALMONELLA)	Form and Instruction	Modified	Repair queued
Form FN.200.3 FoodNet Variable List,_ (LISTERIA MONOCYTOGENES)	Form and Instruction	Modified	Available
Form FN.200.3 FoodNet Variable List_ (LISTERIA MONOCTOGENES)	Form and Instruction	Modified	Missing upstream
Form FN.200.2 FoodNet Variable List_ (CYCLOSPORA)	Form and Instruction	Modified	Available
Form FN.200.2 FoodNet Variable List_ (CYCLOSPORA)	Form and Instruction	Modified	Repair queued
Form FN.200.1 FoodNet Variable List_ (CAMPYLOBACTER)	Form and Instruction	Modified	Available
Form FN.200.1 FoodNet Variable List_(CAMPYLOBACTER)	Form and Instruction	Modified	Missing upstream
Form FSN.300.2 FLUSURV-NET: CONSENT FORM FOR PATIENT/PROXY INTERVIEW	Form and Instruction	Modified	Available
Form FSN.300.2 FLUSURV-NET: CONSENT FORM FOR PATIENT/PROXY INTERVIEW (English/Spanish)	Form and Instruction	Modified	Repair queued
Form FN.200.9 FoodNet CDC's FoodNet Hemolytic Uremic Syndrome (HUS) Surveillance Case Report Form	Form and Instruction	Modified	Available
Form FN.200.9 FoodNet Hemolytic Uremic Syndrome (HUS)	Form and Instruction	Modified	Repair queued
Form FSN.300.1 Influenza Hospitalizatin Surveillance Network (FluSurv-NET) Case Report Form	Form and Instruction	Modified	Repair queued
Form FSN.300.1 FluSurv-Net Influenza Hospitalization Surveillance Network Case Report Form	Form and Instruction	Modified	Repair queued
Form ABC 100.5 ACTIVE BACTERIAL CORE SURVEILLANCE (ABCs) NEONATAL INFECTION EXPANDED TRACKING FORM	Form and Instruction	Modified	Available
Form ABC 100.5 Active Bacterial Core Surveillance (ABCs) Neonatal Infection Expanded Tracking Form	Form and Instruction	Modified	Missing upstream
Form ABC 100.2 ACTIVE BACTERIAL CORE SURVEILLANCE (ABCs) INVASIVE PNEUMOCOCCAL DISEASE IN CHILDREN (aged ≥2 months to <5 years) AND ADULTS (aged ≥65 years)	Form and Instruction	Modified	Available
Form ABC 100.2 ABCs Invasive Pneumococcal Disease in Children and Adults	Form and Instruction	Modified	Available
Form ABC.100.1 Active Bacterial Core Surveillance (ABCs) Case Report	Form and Instruction	Modified	Repair queued
Form ABC.100.1 Active Bacterial Core Surveillance (ABCs) Case Report	Form and Instruction	Modified	Repair queued
2. Supporting Statement Part B_EIP OMB Revision_09162025.docx	Supporting Statement B	Uploaded 2025-11-20	Available
2. Supporting Statement Part B_EIP OMB Revision_09162025.docx	Supporting Statement B	Uploaded 2025-11-20	Repair queued
1. Supporting Statement Part A_EIP OMB Revision_01052026.docx	Supporting Statement A	Uploaded 2026-01-09	Repair queued
1. Supporting Statement Part A_EIP OMB Revision_09162025_v2.docx	Supporting Statement A	Uploaded 2025-11-20	Repair queued
Att. 5-Explanation for Program Changes_SSA.docx	Supplementary Document	Uploaded 2026-01-09	Available
Att. 5-Explanation for Program Changes_SSA.docx	Supplementary Document	Uploaded 2025-11-20	Missing upstream
Att. 4-Human Subjects Determination Memo.pdf	Supplementary Document	Uploaded 2025-11-20	Repair queued
Att. 4-Human Subjects Determination Memo.pdf	Supplementary Document	Uploaded 2025-11-20	Repair queued
Att. 3- 20250916_EIP_PIA.pdf	Supplementary Document	Uploaded 2025-11-20	Available
Att. 3- 20250916_EIP_PIA.pdf	Supplementary Document	Uploaded 2025-11-20	Repair queued
Att. 2-Federal Register 60day FRN 2025-13102.pdf	Supplementary Document	Uploaded 2025-11-20	Available
Att. 2-Federal Register 60day FRN 2025-13102.pdf	Supplementary Document	Uploaded 2025-11-20	Missing upstream
Att. 1-Section 301 of the Public Health Service Act (42 USC 241).pdf	Supplementary Document	Uploaded 2025-11-20	Available
Att. 1-Section 301 of the Public Health Service Act (42 USC 241).pdf	Supplementary Document	Uploaded 2025-11-20	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
278146	HAIC MuGSI KPC and NDM Treatment Collection Form	Form and Instruction	New	HAIC MuGSI KPC and NDM treatment collection form
278146	HAIC MuGSI KPC and NDM Treatment Collection Form	Form and Instruction	New
253051	Data Elements Transferred to CDC for the HAIC Death Ascertainment Project	Form and Instruction	Modified	Data Elements Transferred to CDC for the HAIC Death Ascertainment Project
253051	Data Elements Transferred to CDC for the HAIC Death Ascertainment Project	Form and Instruction	Modified
253049	HAIC Multi-site Gram-negative Surveillance Initiative (MuGSI) Supplemental Surveillance Officer Survey	Form and Instruction	Modified	HAIC Multi-site Gram-negative Surveillance Initiative (MuGSI) Supplemental Surveillance Officer Survey
253049	HAIC Multi-site Gram-negative Surveillance Initiative (MuGSI) Supplemental Surveillance Officer Survey	Form and Instruction	Modified
253048	Community-Associated CP-CRE Interview	Form and Instruction	Modified	Community-Associated CP-CRE Interview
253048	Community-Associated CP-CRE Interview	Form and Instruction	Modified
235058	HAIC_LABORATORY TESTING PRACTICES FOR CANDIDEMIA QUESTIONNAIRE	Form and Instruction	Modified	LABORATORY TESTING PRACTICES FOR CANDIDEMIA QUESTIONNAIRE
235058	HAIC_LABORATORY TESTING PRACTICES FOR CANDIDEMIA QUESTIONNAIRE	Form and Instruction	Modified
235057	HAIC Invasive Staphylococcus aureus Supplemental Surveillance Officer Survey	Form and Instruction	Modified	HAIC Invasive Staphylococcus aureus Supplemental Surveillance Officer Survey
235057	HAIC Invasive Staphylococcus aureus Supplemental Surveillance Officer Survey	Form and Instruction	Modified
235056	CDC's Healthcare-Associated Infections Community Interface (HAIC) Staphylococcus aureus Laboratory Survey	Form and Instruction	Modified	CDC’s Healthcare-Associated Infections Community Interface (HAIC) Staphylococcus aureus Laboratory Survey
235056	CDC's Healthcare-Associated Infections Community Interface (HAIC) Staphylococcus aureus Laboratory Survey	Form and Instruction	Modified
235055	Emerging Infections Program C. difficile Surveillance Nursing Home Telephone Survey	Form and Instruction	Modified	Emerging Infections Program C. difficile Surveillance Nursing Home Telephone Survey
235055	Emerging Infections Program C. difficile Surveillance Nursing Home Telephone Survey	Form and Instruction	Modified
235054	HAIC-Surveillance Officer's Survey	Form and Instruction	Modified	HAIC Surveillance Officer’s Survey
235054	HAIC-Surveillance Officer's Survey	Form and Instruction	Modified
235053	Annual Survey of Laboratory Testing Practices for C. difficile Infection	Form and Instruction	Modified	Annual Survey of Laboratory Testing Practices for C. difficile Infection
235053	Annual Survey of Laboratory Testing Practices for C. difficile Infection	Form and Instruction	Modified
235052	FluSurv-NET Laboratory Survey	Form	Modified	FluSurv-NET Laboratory Survey
235052	FluSurv-NET Laboratory Survey	Form	Modified
235051	FoodNET Lab Survey Variable List	Form	Modified	FoodNET Lab Survey Variable List
235051	FoodNET Lab Survey Variable List	Form	Modified
231114	CANDIDEMIA CASE REPORT FORM	Form and Instruction	Modified	CANDIDEMIA CASE REPORT FORM
231114	CANDIDEMIA CASE REPORT FORM	Form and Instruction	Modified
231113	Invasive Staphylococcus aureus Healthcare-Associated Infections Community Interface (HAIC) Case Report	Form and Instruction	Modified	Invasive Staphylococcus aureus Healthcare-Associated Infections Community Interface (HAIC) Case Report
231113	Invasive Staphylococcus aureus Healthcare-Associated Infections Community Interface (HAIC) Case Report	Form and Instruction	Modified
231111	FLUSURV-NET: PROVIDER PEDIATRIC VACCINATION HISTORY REQUEST LETTER/FORM	Form and Instruction	Modified	FLUSURV-NET: PROVIDER PEDIATRIC VACCINATION HISTORY REQUEST LETTER/FORM
231111	FLUSURV-NET: PROVIDER PEDIATRIC VACCINATION HISTORY REQUEST LETTER/FORM	Form and Instruction	Modified
230869	ABCs Severe GAS Infection: Supplemental Form	Form and Instruction	Removed	ABCs Severe GAS Infection: Supplemental Form
230869	ABCs Severe GAS Infection: Supplemental Form	Form and Instruction	Removed
220380	2019 ABCs H. Influenzae Neonatal Sepsis Expanded Surveillance Form	Form and Instruction	Removed	2019 ABC H. Influenzae Neonatal Sepsis Expanded Surveillance Form
220380	2019 ABCs H. Influenzae Neonatal Sepsis Expanded Surveillance Form	Form and Instruction	Removed
217336	(MuGSI) Healthcare-Associated Infections Community Interface (HAIC) Case Report	Form and Instruction	Modified	Multi-site Gram-Negative Surveillance Initiative (MuGSI) Healthcare-Associated Infections Community Interface (HAIC) Case Report
217336	(MuGSI) Healthcare-Associated Infections Community Interface (HAIC) Case Report	Form and Instruction	Modified
217334	CLOSTRIDIOIDES DIFFICILE INFECTION (CDI) SURVEILLANCE EMERGING INFECTIONS PROGRAM CASE REPORT	Form and Instruction	Modified	CLOSTRIDIOIDES DIFFICILE INFECTION (CDI) SURVEILLANCE EMERGING INFECTIONS PROGRAM CASE REPORT
217334	CLOSTRIDIOIDES DIFFICILE INFECTION (CDI) SURVEILLANCE EMERGING INFECTIONS PROGRAM CASE REPORT	Form and Instruction	Modified
207663	FoodNet Variable List_ (YERSINIA)	Form and Instruction	Modified	FoodNet Variable List_ (YERSINIA)
207663	FoodNet Variable List_ (YERSINIA)	Form and Instruction	Modified
207662	FoodNet Variable List_ (VIBRIO)	Form and Instruction	Modified	FoodNet Variable List_ (VIBRIO)
207662	FoodNet Variable List_ (VIBRIO)	Form and Instruction	Modified
207661	FoodNet Variable List_ (SHIGELLA)	Form and Instruction	Modified	FoodNet Variable List_ (SHIGELLA)
207661	FoodNet Variable List_ (SHIGELLA)	Form and Instruction	Modified
207660	FoodNet Variable List_ (SHIGA TOXIN PRODUCING E.COLI)	Form and Instruction	Modified	FoodNet Variable List_ (SHIGA TOXIN PRODUCING E.COLI)
207660	FoodNet Variable List_ (SHIGA TOXIN PRODUCING E.COLI)	Form and Instruction	Modified
207659	FoodNet Variable List_ (SALMONELLA)	Form and Instruction	Modified	FoodNet Variable List_ (SALMONELLA)
207659	FoodNet Variable List_ (SALMONELLA)	Form and Instruction	Modified
207658	FoodNet Variable List_ (LISTERIA MONOCTOGENES)	Form and Instruction	Modified	FoodNet Variable List,_ (LISTERIA MONOCYTOGENES)
207658	FoodNet Variable List_ (LISTERIA MONOCTOGENES)	Form and Instruction	Modified
207657	FoodNet Variable List_ (CYCLOSPORA)	Form and Instruction	Modified	FoodNet Variable List_ (CYCLOSPORA)
207657	FoodNet Variable List_ (CYCLOSPORA)	Form and Instruction	Modified
207655	FoodNet Variable List_(CAMPYLOBACTER)	Form and Instruction	Modified	FoodNet Variable List_ (CAMPYLOBACTER)
207655	FoodNet Variable List_(CAMPYLOBACTER)	Form and Instruction	Modified
207653	FLUSURV-NET: CONSENT FORM FOR PATIENT/PROXY INTERVIEW (English/Spanish)	Form and Instruction	Modified	FLUSURV-NET: CONSENT FORM FOR PATIENT/PROXY INTERVIEW
207653	FLUSURV-NET: CONSENT FORM FOR PATIENT/PROXY INTERVIEW (English/Spanish)	Form and Instruction	Modified
207652	FoodNet Hemolytic Uremic Syndrome (HUS)	Form and Instruction	Modified	FoodNet CDC's FoodNet Hemolytic Uremic Syndrome (HUS) Surveillance Case Report Form
207652	FoodNet Hemolytic Uremic Syndrome (HUS)	Form and Instruction	Modified
207651	FluSurv-Net Influenza Hospitalization Surveillance Network Case Report Form	Form and Instruction	Modified	Influenza Hospitalizatin Surveillance Network (FluSurv-NET) Case Report Form
207651	FluSurv-Net Influenza Hospitalization Surveillance Network Case Report Form	Form and Instruction	Modified
207649	Active Bacterial Core Surveillance (ABCs) Neonatal Infection Expanded Tracking Form	Form and Instruction	Modified	ACTIVE BACTERIAL CORE SURVEILLANCE (ABCs) NEONATAL INFECTION EXPANDED TRACKING FORM
207649	Active Bacterial Core Surveillance (ABCs) Neonatal Infection Expanded Tracking Form	Form and Instruction	Modified
207648	ABCs Invasive Pneumococcal Disease in Children and Adults	Form and Instruction	Modified	ACTIVE BACTERIAL CORE SURVEILLANCE (ABCs) INVASIVE PNEUMOCOCCAL DISEASE IN CHILDREN (aged ≥2 months to <5 years) AND ADULTS (aged ≥65 years)
207648	ABCs Invasive Pneumococcal Disease in Children and Adults	Form and Instruction	Modified
207646	Active Bacterial Core Surveillance (ABCs) Case Report	Form and Instruction	Modified	Active Bacterial Core Surveillance (ABCs) Case Report
207646	Active Bacterial Core Surveillance (ABCs) Case Report	Form and Instruction	Modified

ICR Details

OMB Control No: 0920-0978	ICR Reference No: 202509-0920-011
Status: Active	Previous ICR Reference No: 202505-0920-009
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-0978
Title: [NCEZID] Emerging Infections Program
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 01/09/2026
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/21/2025
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2029	36 Months From Approved	09/30/2027
Responses	89,088	0	88,158
Time Burden (Hours)	40,733	0	40,013
Cost Burden (Dollars)	0	0	0

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Abstract: The Emerging Infections Programs (EIP) is to 1) detect and monitor emerging pathogens, the diseases they cause, and the factors influencing their emergence, and respond to problems as they are identified, 2) integrate laboratory science and epidemiology to optimize public health practice, 3) strengthen infrastructure to support surveillance and research and to implement prevention and control programs, and to 4) ensure implementation of prevention strategies and communication of public health information about emerging diseases. Surveillance efforts of the core EIP activities generate reliable estimates of the incidence of certain infections and provide the foundation for a variety of epidemiologic studies. This Revision includes adding and deleting forms and other minor changes to forms and documents.

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Authorizing Statute(s): US Code: 42 USC 301 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 31204	07/14/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 47764	10/02/2025
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 31

table that charts list of burden

IC Title	Form No.	Form Name
(MuGSI) Healthcare-Associated Infections Community Interface (HAIC) Case Report	HAIC.400.1	Multi-site Gram-Negative Surveillance Initiative (MuGSI) Healthcare-Associated Infections Community Interface (HAIC) Case Report
2019 ABCs H. Influenzae Neonatal Sepsis Expanded Surveillance Form	ABC.100.3	2019 ABC H. Influenzae Neonatal Sepsis Expanded Surveillance Form
ABCs Invasive Pneumococcal Disease in Children and Adults	ABC 100.2	ACTIVE BACTERIAL CORE SURVEILLANCE (ABCs) INVASIVE PNEUMOCOCCAL DISEASE IN CHILDREN (aged ≥2 months to <5 years) AND ADULTS (aged ≥65 years)
ABCs Severe GAS Infection: Supplemental Form	ABC.100.4	ABCs Severe GAS Infection: Supplemental Form
Active Bacterial Core Surveillance (ABCs) Case Report	ABC.100.1	Active Bacterial Core Surveillance (ABCs) Case Report
Active Bacterial Core Surveillance (ABCs) Neonatal Infection Expanded Tracking Form	ABC 100.5	ACTIVE BACTERIAL CORE SURVEILLANCE (ABCs) NEONATAL INFECTION EXPANDED TRACKING FORM
Annual Survey of Laboratory Testing Practices for C. difficile Infection	HAIC.400.8	Annual Survey of Laboratory Testing Practices for C. difficile Infection
CANDIDEMIA CASE REPORT FORM	HAIC.400.11	CANDIDEMIA CASE REPORT FORM
CDC's Healthcare-Associated Infections Community Interface (HAIC) Staphylococcus aureus Laboratory Survey	HAIC.400.5	CDC’s Healthcare-Associated Infections Community Interface (HAIC) Staphylococcus aureus Laboratory Survey
CLOSTRIDIOIDES DIFFICILE INFECTION (CDI) SURVEILLANCE EMERGING INFECTIONS PROGRAM CASE REPORT	HAIC.400.7	CLOSTRIDIOIDES DIFFICILE INFECTION (CDI) SURVEILLANCE EMERGING INFECTIONS PROGRAM CASE REPORT
Community-Associated CP-CRE Interview	HAIC.400.2	Community-Associated CP-CRE Interview
Data Elements Transferred to CDC for the HAIC Death Ascertainment Project	HAIC.400.13	Data Elements Transferred to CDC for the HAIC Death Ascertainment Project
Emerging Infections Program C. difficile Surveillance Nursing Home Telephone Survey	HAIC.400.10	Emerging Infections Program C. difficile Surveillance Nursing Home Telephone Survey
FLUSURV-NET: CONSENT FORM FOR PATIENT/PROXY INTERVIEW (English/Spanish)	FSN.300.2	FLUSURV-NET: CONSENT FORM FOR PATIENT/PROXY INTERVIEW
FLUSURV-NET: PROVIDER PEDIATRIC VACCINATION HISTORY REQUEST LETTER/FORM	FSN.300.3	FLUSURV-NET: PROVIDER PEDIATRIC VACCINATION HISTORY REQUEST LETTER/FORM
FluSurv-NET Laboratory Survey	FSN.300.4	FluSurv-NET Laboratory Survey
FluSurv-Net Influenza Hospitalization Surveillance Network Case Report Form	FSN.300.1	Influenza Hospitalizatin Surveillance Network (FluSurv-NET) Case Report Form
FoodNET Lab Survey Variable List	FN.200.10	FoodNET Lab Survey Variable List
FoodNet Hemolytic Uremic Syndrome (HUS)	FN.200.9	FoodNet CDC's FoodNet Hemolytic Uremic Syndrome (HUS) Surveillance Case Report Form
FoodNet Variable List_ (CYCLOSPORA)	FN.200.2	FoodNet Variable List_ (CYCLOSPORA)
FoodNet Variable List_ (LISTERIA MONOCTOGENES)	FN.200.3	FoodNet Variable List,_ (LISTERIA MONOCYTOGENES)
FoodNet Variable List_ (SALMONELLA)	FN.200.4	FoodNet Variable List_ (SALMONELLA)
FoodNet Variable List_ (SHIGA TOXIN PRODUCING E.COLI)	FN.200.5	FoodNet Variable List_ (SHIGA TOXIN PRODUCING E.COLI)
FoodNet Variable List_ (SHIGELLA)	FN.200.6	FoodNet Variable List_ (SHIGELLA)
FoodNet Variable List_ (VIBRIO)	FN.200.7	FoodNet Variable List_ (VIBRIO)
FoodNet Variable List_ (YERSINIA)	FN.200.8	FoodNet Variable List_ (YERSINIA)
FoodNet Variable List_(CAMPYLOBACTER)	FN.200.1	FoodNet Variable List_ (CAMPYLOBACTER)
HAIC Invasive Staphylococcus aureus Supplemental Surveillance Officer Survey	HAIC.400.6	HAIC Invasive Staphylococcus aureus Supplemental Surveillance Officer Survey
HAIC MuGSI KPC and NDM Treatment Collection Form	HAIC.400.14	HAIC MuGSI KPC and NDM treatment collection form
HAIC Multi-site Gram-negative Surveillance Initiative (MuGSI) Supplemental Surveillance Officer Survey	HAIC.400.3	HAIC Multi-site Gram-negative Surveillance Initiative (MuGSI) Supplemental Surveillance Officer Survey
HAIC-Surveillance Officer's Survey	HAIC.400.9	HAIC Surveillance Officer’s Survey
HAIC_LABORATORY TESTING PRACTICES FOR CANDIDEMIA QUESTIONNAIRE	HAIC.400.12	LABORATORY TESTING PRACTICES FOR CANDIDEMIA QUESTIONNAIRE
Invasive Staphylococcus aureus Healthcare-Associated Infections Community Interface (HAIC) Case Report	HAIC.400.4	Invasive Staphylococcus aureus Healthcare-Associated Infections Community Interface (HAIC) Case Report

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	89,088	88,158	0	930	0	0
Annual Time Burden (Hours)	40,733	40,013	0	720	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Two forms were removed and one was added.

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Annual Cost to Federal Government: $41,699,051

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 11/21/2025

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