Information Collection

HAIC (MuGSI) Supplemental Surveillance Officer Survey

IC 253049 under ICR 202309-0920-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Form C5342262-A HAIC (MuGSI) Supplemental Surveillance Officer Survey Form and Instruction
C5342262-A 2024 Multi-site Gram-Negative Surveillance Initiative (M Att11_HAIC_FINAL - 2024 MuGSI SO Survey_081023.pdf Form and Instruction
C5342262-A 2024 Multi-site Gram-Negative Surveillance Initiative (M Att11_HAIC_FINAL - 2024 MuGSI SO Survey_081023.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	HAIC (MuGSI) Supplemental Surveillance Officer Survey	Agency IC Tracking Number:	0920-0978-23HY

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	C5342262-A	2024 Multi-site Gram-Negative Surveillance Initiative (MuGSI) Healthcare-Associated Infections Community Interface (HAIC) Case Report	Att11_HAIC_FINAL - 2024 MuGSI SO Survey_081023.pdf		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 %

	Requested	Previously Approved
Annual Number of Responses for this IC	10	10
Annual IC Time Burden (Hours)	3	3
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.