Post-discharge Hospital Patients without MRSA Infection (Control-Patients) Screening and Consent

Risk Factors for Invasive Methicillin-Resistant Staphylococcus aureus (MRSA) among Patients Recently Discharged from Acute Care Hospitals

Documents and Forms

Document Name Document Type
Attachment F-Screening questions HACO_revised 3_cleaned.docx Instruction

Information Collection (IC) Details

IC Title:	Post-discharge Hospital Patients without MRSA Infection (Control-Patients) Screening and Consent	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

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 300	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	25	25
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.