HAIC MuGSI KPC and NDM Treatment Collection Form

[NCEZID] Emerging Infections Program

Documents and Forms

Document Name Document Type
Form HAIC.400.14 HAIC MuGSI KPC and NDM Treatment Collection Form Form and Instruction
HAIC.400.14 HAIC MuGSI KPC and NDM treatment collection form HAIC.400.14 - NDM and KPC Treatment Form.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	HAIC MuGSI KPC and NDM Treatment Collection Form	Agency IC Tracking Number:	0920-0978

Is this a Common Form? No		IC Status: New

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.400.14	HAIC MuGSI KPC and NDM treatment collection form	HAIC.400.14 - NDM and KPC Treatment Form.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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	600	600
Annual IC Time Burden (Hours)	600	600
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.