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Invasive Staphylococcus aureus Healthcare-Associated Infections Community Interface (HAIC) Case Report
[NCEZID] Emerging Infections Program
OMB: 0920-0978
IC ID: 231113
OMB.report
HHS/CDC
OMB 0920-0978
ICR 202505-0920-009
IC 231113
( )
Documents and Forms
Document Name
Document Type
Form HAIC 400.4
Invasive Staphylococcus aureus Healthcare-Associated Infections Community Interface (HAIC) Case Report
Form and Instruction
HAIC 400.4 2024 Invasive Staphylococcus aureus Healthcare-Associate
HAIC_400_4_iSA2024_CRF_2025update2.pdf
Form and Instruction
HAIC 400.4 2025 Invasive Staphylococcus aureus Healthcare-Associate
HAIC_400_4_iSA2025_CRF_v2.pdf
Form and Instruction
HAIC 400.4 2022 Invasive Methicillin-Resistant Staphylococcus aureu
HAIC_400_4_MRSA2022_FINAL2_2025update2.pdf
Form and Instruction
HAIC 400.4 2023 Invasive Methicillin-Resistant Staphylococcus aureu
HAIC_400_4_MRSA2023_2025update2.pdf
Form and Instruction
HAIC 400.4 2022 Invasive Methicillin-Sensitive Staphylococcus aureu
HAIC_400_4_MSSA2022_FINAL2_2025updated2.pdf
Form and Instruction
HAIC 400.4 2023 Invasive Methicillin-Sensitive Staphylococcus aureu
HAIC_400_4_MSSA2023_2025update2.pdf
Form and Instruction
HAIC 400.4 HAIC.400.4 Invasive Staphylococcus aureus HAIC Case Repo
HAIC.400.4_iSA2026_CRF.pdf
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Invasive Staphylococcus aureus Healthcare-Associated Infections Community Interface (HAIC) Case Report
Agency IC Tracking Number:
0920-0978
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
HAIC 400.4
2024 Invasive Staphylococcus aureus Healthcare-Associated Infections Community Interface (HAIC) Case Report_rev 2025
HAIC_400_4_iSA2024_CRF_2025update2.pdf
N/A
Yes
Yes
Fillable Fileable
Form and Instruction
HAIC 400.4
2025 Invasive Staphylococcus aureus Healthcare-Associated Infections Community Interface (HAIC) Case Report_rev 2025
HAIC_400_4_iSA2025_CRF_v2.pdf
N/A
Yes
Yes
Fillable Fileable
Form and Instruction
HAIC 400.4
2022 Invasive Methicillin-Resistant Staphylococcus aureus Healthcare-Associated Infections Community Interface (HAIC) Case Report _rev 2025
HAIC_400_4_MRSA2022_FINAL2_2025update2.pdf
N/A
Yes
Yes
Fillable Fileable
Form and Instruction
HAIC 400.4
2023 Invasive Methicillin-Resistant Staphylococcus aureus Healthcare-Associated Infections Community Interface (HAIC) Case Report _rev 2025
HAIC_400_4_MRSA2023_2025update2.pdf
N/A
Yes
Yes
Fillable Fileable
Form and Instruction
HAIC 400.4
2022 Invasive Methicillin-Sensitive Staphylococcus aureus Healthcare-Associated Infections Community Interface (HAIC) Case Report _rev 2025
HAIC_400_4_MSSA2022_FINAL2_2025updated2.pdf
N/A
Yes
Yes
Fillable Fileable
Form and Instruction
HAIC 400.4
2023 Invasive Methicillin-Sensitive Staphylococcus aureus Healthcare-Associated Infections Community Interface (HAIC) Case Report _rev 2025
HAIC_400_4_MSSA2023_2025update2.pdf
N/A
Yes
Yes
Fillable Fileable
Form and Instruction
HAIC 400.4
HAIC.400.4 Invasive Staphylococcus aureus HAIC Case Report - 2026
HAIC.400.4_iSA2026_CRF.pdf
N/A
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
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 %
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
7,880
0
0
0
0
7,880
Annual IC Time Burden (Hours)
3,809
0
0
0
0
3,809
Annual IC Cost Burden (Dollars)
0
0
0
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.