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Post-discharge Hospital Patients with MRSA (Case Patients) - Screening and Consent Process
Risk Factors for Invasive Methicillin-Resistant Staphylococcus aureus (MRSA) among Patients Recently Discharged from Acute Care Hospitals
OMB: 0920-0958
IC ID: 205888
OMB.report
HHS/CDC
OMB 0920-0958
ICR 201302-0920-016
IC 205888
( )
Documents and Forms
Document Name
Document Type
Attachment F-Screening questions HACO_revised 3_cleaned.docx
Instruction
Attachment E - Verbal Consent.revised docx.docx
Attachment E - Verbal Consent.revised docx
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Post-discharge Hospital Patients with MRSA (Case Patients) - Screening and Consent Process
Agency IC Tracking Number:
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
Instruction
Attachment F-Screening questions HACO_revised 3_cleaned.docx
Yes
Yes
Printable Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Immunization Management
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
150
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
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
150
0
150
0
0
0
Annual IC Time Burden (Hours)
13
0
13
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Attachment E - Verbal Consent.revised docx
Attachment E - Verbal Consent.revised docx.docx
02/14/2013
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.