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Pseudomonas NICU_CA
Emergency Epidemic Investigation Data Collections - Expedited Reviews
OMB: 0920-1011
IC ID: 213233
OMB.report
HHS/CDC
OMB 0920-1011
ICR 201601-0920-017
IC 213233
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1011 can be found here:
2022-10-07 - Revision of a currently approved collection
2022-01-13 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Appendix 1_chart abstraction tool_2014019_Pseudomonas NICU _CA.docx
Other-WORD
Appendix_2_hand hygiene audit tool_2014019_Pseudomonas NICU_CA.doc
Other-WORD
Appendix 3_CLABSI Checklist_2014019_Pseudomonas NICU_CA.pdf
Other-WORD
Appendix 4_healthcare personnel interview_2014019_Pseudomonas NICU_CA.docx
Other-WORD
2014019-078_Pseudomonas NICU_CA.docx
Request for Approval
IC Document
CA Letter of Invite Pseudomonas NICU.docx
Letter of Invitation
IC Document
0920-1011 GenIC Request Pseudomonas NICU_CA.msg
Completed GenIC Form
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Pseudomonas NICU_CA
Agency IC Tracking Number:
14AZS
IC Status:
Unchanged
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
Other-WORD
Appendix_2_hand hygiene audit tool_2014019_Pseudomonas NICU_CA.doc
No
Fillable Printable
Other-WORD
Appendix 3_CLABSI Checklist_2014019_Pseudomonas NICU_CA.pdf
No
Fillable Printable
Other-WORD
Appendix 4_healthcare personnel interview_2014019_Pseudomonas NICU_CA.docx
No
Fillable Printable
Other-WORD
Appendix 1_chart abstraction tool_2014019_Pseudomonas NICU _CA.docx
No
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
235
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
0 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
235
0
0
0
0
235
Annual IC Time Burden (Hours)
43
0
0
0
0
43
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Request for Approval
2014019-078_Pseudomonas NICU_CA.docx
09/24/2014
Letter of Invitation
CA Letter of Invite Pseudomonas NICU.docx
09/24/2014
Completed GenIC Form
0920-1011 GenIC Request Pseudomonas NICU_CA.msg
09/24/2014
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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