Information Collection

Invasive Methicillin - Resistant - Staphylococcus aureus ABCs Case Report Form

IC 207647 under ICR 201612-0920-015 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Invasive Methicillin - Resistant - Staphylococcus aureus ABCs Case Report Form Form
Invasive Methicillin-Resistant Staph Attachment2_ABCs_MRSA_CRF_Feb2014.pdf Form
CDC 52.15B Rev 10- Healthcare-Associated Infections Community Interface (HA Att. 7 - MRSA Form.pdf Form
CDC 52.15B Rev 09- Invasive Methicillin-Resistant Staphylococcus aureus HAI Att. E - 16_270050_MRSA2017_OMB_v2.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Invasive Methicillin - Resistant - Staphylococcus aureus ABCs Case Report Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 301 Public Health Service Act

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Invasive Methicillin-Resistant Staph	Attachment2_ABCs_MRSA_CRF_Feb2014.pdf		Yes	Yes	Fillable Fileable
Form	CDC 52.15B Rev 10-2015	Healthcare-Associated Infections Community Interface (HACI) Case Report -2016	Att. 7 - MRSA Form.pdf		Yes	Yes	Fillable Fileable
Form	CDC 52.15B Rev 09-2016	Invasive Methicillin-Resistant Staphylococcus aureus HAIC Case Report - 2017	Att. E - 16_270050_MRSA2017_OMB_v2.pdf	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

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	6,090	6,090
Annual IC Time Burden (Hours)	2,030	2,030
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.