[NCEZID] Emerging Infections Program

OMB 0920-0978

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 is a request for a non-substantive change. Requested changes represent minor modifications to already-approved instruments to include a limited number of data elements pertaining to COVID-19.

The latest form for [NCEZID] Emerging Infections Program expires 2022-04-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form 0920-0978 HAIC Death Ascertainment Project Form and Instruction
Form 0920-0978 HAIC Death Ascertainment Project Form and Instruction
Form 0920-0978 HAIC Multi-site Gram-negative Surveillance Initiative (MuGSI) Supplemental Surveillance Officer Survey Form and Instruction
Form 0920-0978 HAIC Multi-site Gram-negative Surveillance Initiative (MuGSI) Supplemental Surveillance Officer Survey Form and Instruction
Form 0920-0978 HAIC MuGSI CA CP-CRE Health interview Form and Instruction
Form 0920-0978 HAIC MuGSI CA CP-CRE Health interview Form and Instruction
Form 2024 HAIC- Laboratory Testing Practices for Candidemia Questionnaire Form and Instruction
Form 2024 HAIC- Laboratory Testing Practices for Candidemia Questionnaire Form and Instruction
Form 0920-0978 HAIC Invasive Staphylococcus aureus Annual Surveillance Officers Survey Form and Instruction
Form 0920-0978 HAIC Invasive Staphylococcus aureus Annual Surveillance Officers Survey Form and Instruction
Form 0920-0978 HAIC Invasive Staphylococcus aureus Annual Laboratory Survey Form and Instruction
Form 0920-0978 HAIC Invasive Staphylococcus aureus Annual Laboratory Survey Form and Instruction
Form 0920-0978 HAIC- EIP C. difficile Surveillance Nursing Home Telephone Survey (LTCF) Form and Instruction
Form 0920-0978 HAIC- EIP C. difficile Surveillance Nursing Home Telephone Survey (LTCF) Form and Instruction
Form 0920-0978 HAIC- CDI Annual Surveillance Officers Survey Form and Instruction
Form 0920-0978 HAIC- CDI Annual Surveillance Officers Survey Form and Instruction
Form 0920-0978 HAIC- Annual Survey of Laboratory Testing Practices for C. difficile Infections Form and Instruction
Form 0920-0978 HAIC- Annual Survey of Laboratory Testing Practices for C. difficile Infections Form and Instruction
Form CS341327-A 7/31/20 Flu Surv NET Laboratory Survey Form
Form CS341327-A 7/31/20 Flu Surv NET Laboratory Survey Form
Form Short Form 2024 HAIC Candidemia Case Report Form Form and Instruction
Form Short Form 2024 HAIC Candidemia Case Report Form Form and Instruction
Form CDC 52.15B Rev.07- HAIC Invasive Staphylococcus aureus Case Report – 2024 Form and Instruction
Form CDC 52.15B Rev.07- HAIC Invasive Staphylococcus aureus Case Report – 2024 Form and Instruction
Form 0920-0978 HAIC Multi-Site Gram-Negative Surveillance Initiative - Extended Spectrum Beta-Lactamase Producing Enterobacteriaceae (MuGSI-ESBL) Form
Form 0920-0978 HAIC Multi-Site Gram-Negative Surveillance Initiative - Extended Spectrum Beta-Lactamase Producing Enterobacteriaceae (MuGSI-ESBL) Form
Form 0920-0978-24BX FluSurv-Net Influenza Hospitalization Surveillance Project Provider Vaccination History Fax Form (Children/Adults) Form and Instruction
Form 0920-0978-24BX FluSurv-Net Influenza Hospitalization Surveillance Project Provider Vaccination History Fax Form (Children/Adults) Form and Instruction
Form 0920-0978 Influenza Hospitalization Surveillance Project Vaccination Telephone Script / Consent Form (Spanish) Form and Instruction
Form 0920-0978 Influenza Hospitalization Surveillance Project Vaccination Telephone Script / Consent Form (Spanish) Form and Instruction
Form 0920-0978 ABCs Severe GAS Infection Supplemental Form Form and Instruction
Form 0920-0978 ABCs Severe GAS Infection Supplemental Form Form and Instruction
Form 0920-0978 ABCs H. Influenzae Neonatal Sepsis Expanded Surveillance Form Form and Instruction
Form 0920-0978 ABCs H. Influenzae Neonatal Sepsis Expanded Surveillance Form Form and Instruction
Form CS342262-A 9/20/20 HAIC Multi-Site Gram-Negative Surveillance Initiative (MUGSI) Case Report Form Form
Form CS342262-A 9/20/20 HAIC Multi-Site Gram-Negative Surveillance Initiative (MUGSI) Case Report Form Form
Form CS 342179-A 8/3/20 HAIC - CDI Case Report and Treatment Form Form and Instruction
Form CS 342179-A 8/3/20 HAIC - CDI Case Report and Treatment Form Form and Instruction
Form 0920-0978-24BX FluSurv-Net Influenza Hospitalization Surveillance Project Vaccination Phone Script and Consent Form (English/Spanish) Form and Instruction
Form 0920-0978-24BX FluSurv-Net Influenza Hospitalization Surveillance Project Vaccination Phone Script and Consent Form (English/Spanish) Form and Instruction
Form 0920-0978 FoodNet Hemolytic Uremic Syndrome (HUS) Form and Instruction
Form 0920-0978 FoodNet Hemolytic Uremic Syndrome (HUS) Form and Instruction
Form CS340190-A FluSurv-Net Influenza Hospitalization Surveillance Network Case Report Form Form and Instruction
Form CS340190-A FluSurv-Net Influenza Hospitalization Surveillance Network Case Report Form Form and Instruction
Form 0920-0978 Active Bacterial Core Surveillance (ABCs) Neonatal Infection Expanded Tracking Form Form and Instruction
Form 0920-0978 Active Bacterial Core Surveillance (ABCs) Neonatal Infection Expanded Tracking Form Form and Instruction
Form CDC 52.15A REV.8-2 ABCs Invasive Pneumococcal Disease in Children and Adults Form and Instruction
Form CDC 52.15A REV.8-2 ABCs Invasive Pneumococcal Disease in Children and Adults Form and Instruction
Form 0920-0978 HAIC Invasive Methicillin-resistant Staphylococcus aureus (MRSA) Form and Instruction
Form 0920-0978 HAIC Invasive Methicillin-resistant Staphylococcus aureus (MRSA) Form and Instruction
Form CDC 52.12A REV 201 2024 Active Bacterial Core Surveillance (ABCs) Case Report Form and Instruction
Form CDC 52.12A REV 201 2024 Active Bacterial Core Surveillance (ABCs) Case Report Form and Instruction
Att2_EIP2024_NonSub_Crosswalk_Dec21.docx Supplementary Document
Att2_EIP2024_NonSub_Crosswalk_Dec21.docx Supplementary Document
Att1_EIP2024_NonSub_DescriptionChanges_Dec21.docx Supplementary Document
Att1_EIP2024_NonSub_DescriptionChanges_Dec21.docx Supplementary Document
EIP 0920-0978_Non-sub change request.docx Justification for No Material/Nonsubstantive Change
EIP 0920-0978_Non-sub change request.docx Justification for No Material/Nonsubstantive Change
Att10_COVID-19 Vaccination Status on FluSurv-NET Cases_20220808.pdf Supplementary Document
Att10_COVID-19 Vaccination Status on FluSurv-NET Cases_20220808.pdf Supplementary Document
EIP 0920-0978_Non-sub change request_Oct2022FOR2023.docx Justification for No Material/Nonsubstantive Change
EIP 0920-0978_Non-sub change request_Oct2022FOR2023.docx Justification for No Material/Nonsubstantive Change
Att1_EIP2023_NonSub_DescriptionChanges_OCT2022.docx Justification for No Material/Nonsubstantive Change
Att1_EIP2023_NonSub_DescriptionChanges_OCT2022.docx Justification for No Material/Nonsubstantive Change
Att2_EIP2023_NonSub_Crosswalk_OCT2022.docx Supplementary Document
Att2_EIP2023_NonSub_Crosswalk_OCT2022.docx Supplementary Document
Att23- HAIC CA CP-CRE interview project manual.pdf Supplementary Document
Att23- HAIC CA CP-CRE interview project manual.pdf Supplementary Document
EIP CDI ICMS PIA Signed 2.pdf Supplementary Document
EIP CDI ICMS PIA Signed 2.pdf Supplementary Document
MuGSI PIA Signed.pdf Supplementary Document
MuGSI PIA Signed.pdf Supplementary Document
Att2- 60-Day FRN_2022.docx Supplementary Document
Att2- 60-Day FRN_2022.docx Supplementary Document
Att1- Authorizing_Regulations_T42_section_241.pdf Supplementary Document
Att1- Authorizing_Regulations_T42_section_241.pdf Supplementary Document
SSB_EIP 2022 Revision_04052022.docx Supporting Statement B
SSB_EIP 2022 Revision_04052022.docx Supporting Statement B
SSA_EIP 2022 Revision_04212022_SMN_Clean final_Updated_020723_highlighted edits_final OMB_final.docx Supporting Statement A
SSA_EIP 2022 Revision_04212022_SMN_Clean final_Updated_020723_highlighted edits_final OMB_final.docx Supporting Statement A
HAIC Death Ascertainment Project Form and Instruction
HAIC Death Ascertainment Project Form and Instruction
HAIC Multi-site Gram-negative Surveillance Initiative (MuGSI) Supplemental Surveillance Officer Survey Form and Instruction
HAIC Multi-site Gram-negative Surveillance Initiative (MuGSI) Supplemental Surveillance Officer Survey Form and Instruction
HAIC MuGSI CA CP-CRE Health interview Form and Instruction
HAIC MuGSI CA CP-CRE Health interview Form and Instruction
HAIC- Laboratory Testing Practices for Candidemia Questionnaire Form and Instruction
HAIC- Laboratory Testing Practices for Candidemia Questionnaire Form and Instruction
HAIC Invasive Staphylococcus aureus Annual Surveillance Officers Survey Form and Instruction
HAIC Invasive Staphylococcus aureus Annual Surveillance Officers Survey Form and Instruction
HAIC Invasive Staphylococcus aureus Annual Laboratory Survey Form and Instruction
HAIC Invasive Staphylococcus aureus Annual Laboratory Survey Form and Instruction
HAIC- EIP C. difficile Surveillance Nursing Home Telephone Survey (LTCF) Form and Instruction
HAIC- EIP C. difficile Surveillance Nursing Home Telephone Survey (LTCF) Form and Instruction
HAIC- CDI Annual Surveillance Officers Survey Form and Instruction
HAIC- CDI Annual Surveillance Officers Survey Form and Instruction
HAIC- Annual Survey of Laboratory Testing Practices for C. difficile Infections Form and Instruction
HAIC- Annual Survey of Laboratory Testing Practices for C. difficile Infections Form and Instruction
Flu Surv NET Laboratory Survey Form
Flu Surv NET Laboratory Survey Form
Foodnet Clinical Laboratory Practices and Testing Volume Other-Variable List 2024
HAIC Candidemia Case Report Form Form and Instruction
HAIC Candidemia Case Report Form Form and Instruction
HAIC Invasive Staphylococcus aureus Case Report – 2024 Form and Instruction
HAIC Invasive Staphylococcus aureus Case Report – 2024 Form and Instruction
HAIC Multi-Site Gram-Negative Surveillance Initiative - Extended Spectrum Beta-Lactamase Producing Enterobacteriaceae (MuGSI-ESBL) Form
HAIC Multi-Site Gram-Negative Surveillance Initiative - Extended Spectrum Beta-Lactamase Producing Enterobacteriaceae (MuGSI-ESBL) Form
FluSurv-Net Influenza Hospitalization Surveillance Project Provider Vaccination History Fax Form (Children/Adults) Form and Instruction
FluSurv-Net Influenza Hospitalization Surveillance Project Provider Vaccination History Fax Form (Children/Adults) Form and Instruction
Influenza Hospitalization Surveillance Project Vaccination Telephone Script / Consent Form (Spanish) Form and Instruction
Influenza Hospitalization Surveillance Project Vaccination Telephone Script / Consent Form (Spanish) Form and Instruction
ABCs Severe GAS Infection Supplemental Form Form and Instruction
ABCs Severe GAS Infection Supplemental Form Form and Instruction
ABCs H. Influenzae Neonatal Sepsis Expanded Surveillance Form Form and Instruction
ABCs H. Influenzae Neonatal Sepsis Expanded Surveillance Form Form and Instruction
HAIC Multi-Site Gram-Negative Surveillance Initiative (MUGSI) Case Report Form Form
HAIC Multi-Site Gram-Negative Surveillance Initiative (MUGSI) Case Report Form Form
HAIC - CDI Case Report and Treatment Form Form and Instruction
HAIC - CDI Case Report and Treatment Form Form and Instruction
FoodNet Yersinia Other-Variable list
FoodNet Vibrio Other-Variable list
FoodNet Shigella Other-Variable list
FoodNet Shiga toxin producing E. coli Other-Variable list
FoodNet Salmonella Other-Variable list
FoodNet Listeria monocytogenes Other-Variable list
FoodNet Cyclospora Other-Variable list
FoodNet Campylobacter Other-Variable list
FluSurv-Net Influenza Hospitalization Surveillance Project Vaccination Phone Script and Consent Form (English/Spanish) Form and Instruction
FluSurv-Net Influenza Hospitalization Surveillance Project Vaccination Phone Script and Consent Form (English/Spanish) Form and Instruction
FoodNet Hemolytic Uremic Syndrome (HUS) Form and Instruction
FoodNet Hemolytic Uremic Syndrome (HUS) Form and Instruction
FluSurv-Net Influenza Hospitalization Surveillance Network Case Report Form Form and Instruction
FluSurv-Net Influenza Hospitalization Surveillance Network Case Report Form Form and Instruction
Active Bacterial Core Surveillance (ABCs) Neonatal Infection Expanded Tracking Form Form and Instruction
Active Bacterial Core Surveillance (ABCs) Neonatal Infection Expanded Tracking Form Form and Instruction
ABCs Invasive Pneumococcal Disease in Children and Adults Form and Instruction
ABCs Invasive Pneumococcal Disease in Children and Adults Form and Instruction
HAIC Invasive Methicillin-resistant Staphylococcus aureus (MRSA) Form and Instruction
HAIC Invasive Methicillin-resistant Staphylococcus aureus (MRSA) Form and Instruction
2024 Active Bacterial Core Surveillance (ABCs) Case Report Form and Instruction
2024 Active Bacterial Core Surveillance (ABCs) Case Report Form and Instruction

All Historical Document Collections

202312-0920-011 Approved with change	No material or nonsubstantive change to a currently approved collection	2023-12-29
202309-0920-002 Improperly submitted and continue	No material or nonsubstantive change to a currently approved collection	2023-09-12
202302-0920-009 Approved without change	No material or nonsubstantive change to a currently approved collection	2023-03-01
202204-0920-008 Approved without change	Revision of a currently approved collection	2022-04-25
202112-0920-010 Approved without change	No material or nonsubstantive change to a currently approved collection	2021-12-15
202108-0920-013 Approved without change	No material or nonsubstantive change to a currently approved collection	2021-08-26
202011-0920-004 Approved with change	No material or nonsubstantive change to a currently approved collection	2020-11-16
202009-0920-004 Approved without change	No material or nonsubstantive change to a currently approved collection	2020-09-09
202007-0920-014 Approved with change	No material or nonsubstantive change to a currently approved collection	2020-07-29
202006-0920-015 Approved without change	No material or nonsubstantive change to a currently approved collection	2020-06-25
201910-0920-008 Approved with change	No material or nonsubstantive change to a currently approved collection	2019-10-29
201902-0920-001 Approved without change	Revision of a currently approved collection	2019-02-27
201808-0920-022 Approved with change	No material or nonsubstantive change to a currently approved collection	2018-08-30
201805-0920-010 Approved without change	No material or nonsubstantive change to a currently approved collection	2018-06-05
201803-0920-010 Approved without change	Revision of a currently approved collection	2018-04-25
201801-0920-004 Approved without change	No material or nonsubstantive change to a currently approved collection	2018-01-24
201705-0920-001 Approved without change	No material or nonsubstantive change to a currently approved collection	2017-05-04
201612-0920-015 Approved without change	No material or nonsubstantive change to a currently approved collection	2016-12-30
201603-0920-001 Approved without change	No material or nonsubstantive change to a currently approved collection	2016-03-02
201507-0920-003 Approved with change	Revision of a currently approved collection	2015-07-13
201502-0920-009 Approved without change	No material or nonsubstantive change to a currently approved collection	2015-02-17
201501-0920-018 Withdrawn and continue	No material or nonsubstantive change to a currently approved collection	2015-01-22
201402-0920-016 Approved without change	No material or nonsubstantive change to a currently approved collection	2014-02-28
201309-0920-007 Approved without change	No material or nonsubstantive change to a currently approved collection	2013-09-19
201307-0920-003 Approved without change	New collection (Request for a new OMB Control Number)	2013-07-08

OMB Details

ABCs Case Report Form

Federal Enterprise Architecture: Health - Consumer Health and Safety

Form 0920-0978

2020 ABC Surveillance Case Report

Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.