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Pediatrice Control Subjects Telephone Interview
Risk Factors for Community-Associated Clostridium difficile Infection through the Emerging Infections Program
OMB: 0920-1013
IC ID: 210434
OMB.report
HHS/CDC
OMB 0920-1013
ICR 201406-0920-019
IC 210434
( )
Documents and Forms
Document Name
Document Type
Form 0920
Pediatrice Control Subjects Telephone Interview
Form and Instruction
0920 Attachment G_Pediatric Interview Form
Attachment G_Pediatric Interview Form 1_24_14.docx
Form and Instruction
SPANISH TRANSLATION_Attachment N_CA CDI Pediatric Patient Interview Form_1_24_14.doc
SPANISH TRANSLATION_Attachment N_CA CDI Pediatric Patient Interview Form
IC Document
Attachment G Spanish_CA CDI Pediatric Patient Interview Form_July 15.2014_1.doc
Attachment G Spanish_CA CDI Pediatric Patient Interview Form_July 15.2014_1
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Pediatrice Control Subjects Telephone Interview
Agency IC Tracking Number:
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
0920
Attachment G_Pediatric Interview Form
Attachment G_Pediatric Interview Form 1_24_14.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Immunization Management
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
78
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
78
0
0
0
0
78
Annual IC Time Burden (Hours)
39
0
0
0
0
39
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
SPANISH TRANSLATION_Attachment N_CA CDI Pediatric Patient Interview Form
SPANISH TRANSLATION_Attachment N_CA CDI Pediatric Patient Interview Form_1_24_14.doc
02/17/2014
Attachment G Spanish_CA CDI Pediatric Patient Interview Form_July 15.2014_1
Attachment G Spanish_CA CDI Pediatric Patient Interview Form_July 15.2014_1.doc
07/17/2014
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.