Information Collection

HAIC Candidemia Periodic Laboratory Survey

IC 235058 under ICR 202108-0920-013 · 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⚠️ Notice: This information collection may be referencing outdated material.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
HAIC Candidemia Periodic Laboratory Survey Form and Instruction
Candidemia Lab Survey Att15_2022 Laboratory Survey Candidemia.pdf Form and Instruction
Candidemia Lab Survey Att15_2022 Laboratory Survey Candidemia.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	HAIC Candidemia Periodic Laboratory Survey	Agency IC Tracking Number:	0920-0978 19BPK

Is this a Common Form? No		IC Status: Modified

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	none	Candidemia Lab Survey	Att15_2022 Laboratory Survey Candidemia.pdf		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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	200	0	200
Annual IC Time Burden (Hours)	40	3	37
Annual IC Cost Burden (Dollars)	0	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.