| 2015 EIP Change Request Submission |
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| Below are the EIP forms that have been revised and their associated changes in burden hours. |
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| Activity Area |
Original Document |
New Document |
Burden Hours Change |
| ABCs |
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Attachment 3: 2012 Active Bacterial Core Surveillance (ABCs) CASE REPORT |
Attachment 1: 2015 Active Bacterial Core Surveillance (ABCs) CASE REPORT |
No Change in Hours |
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Attachment 5: 2012 ABCs Invasive Pneumococcal Disease in Children Case Report Form |
Attachment 2: ABCs Invasive Pneumococcal Disease in Children Case Report Form |
Decrease of 36 hours |
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NEW FORM |
Attachment 3: ABCs Non-Bacteremic Pneumococcal Disease Case Report Form |
Increase of 167 hours |
| FoodNet |
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Attachment 21: 2012 FoodNet Variable List |
Attachment 4: 2014 FoodNet Variable List |
No change in Burden Hours |
| Flu |
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Attachment 8: 2011-12 FluSurv-NET Influenza Hospitalization Surveillance Project Case Report Form |
Attachment 5: 2014-15 FluSurv-NET Influenza Surveillance Project Case Report Form |
No change in Burden Hours |
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Attachment 16: Flu Hosp Project Vaccination History Telephone Scripts |
Attachment 6: 2014-2015 FluSurv-NET Influenza Surveillance Project Vaccination History Telephone Survey (ENGLISH) |
No change in Burden Hours |
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Attachment 16: Flu Hosp Project Vaccination History Telephone Scripts |
Attachment 7: 2014-2015 FluSurv-NET Influenza Surveillance Project Vaccination History Telephone Survey (SPANISH) |
No change in Burden Hours |
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Attachment 17: Flu Hosp Project Consent Form |
Attachment 8: 2014-2015 FluSurv-NET Influenza Surveillance Project Consent Form (ENGLISH) |
No change in Burden Hours |
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Attachment 17: Flu Hosp Project Consent Form |
Attachment 9: 2014-2015 FluSurv-NET Influenza Surveillance Project Consent Form (SPANISH) |
No change in Burden Hours |
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| Activity Area |
Original Document |
New Document |
Burden Hours Added |
| HAIC |
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N/A - NEW FORM |
Attachment 10: CDI Case Report Form |
Added 5500 hours |
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N/A - NEW FORM |
Attachment 11: CDI Treatment Form |
Added 2750 hours |
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N/A - NEW FORM |
Attachment 14: CDI Screening Form |
Added 50 hours |
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N/A - NEW FORM |
Attachment 15: CDI Telephone Interview Script |
Added 333 hours |
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N/A - NEW FORM |
Attachment 16: Resistant Gram-Negative Bacilli Case Report Form |
Added 1667 hours |