2024-15967. Agency Forms Undergoing Paperwork Reduction Act Review

Estimated Annualized Burden Hours

Type of respondent	Form No.	Form name	Number of respondents	Number of responses per respondent	Average burden per response (in hours)
State Health Department	ABC.100.1	ABCs Case Report Form	10	809	20/60
	ABC.100.2	ABCs Invasive Pneumococcal Disease in Children and Adults Case Report Form	10	127	10/60
	ABC.100.3	ABCs H. influenzae Neonatal Sepsis Expanded Surveillance Form	10	6	10/60
	ABC.100.4	ABCs Severe GAS Infection Supplemental Form	10	136	20/60
	ABC.100.5	ABCs Neonatal Infection Expanded Tracking Form	10	37	20/60
	FN.200.1	FoodNet Campylobacter	10	970	21/60
	FN.200.2	FoodNet Cyclospora	10	42	10/60
	FN.200.3	FoodNet Listeria monocytogenes	10	16	20/60
	FN.200.4	FoodNet Salmonella	10	855	21/60
	FN.200.5	FoodNet Shiga toxin producing E. coli	10	290	20/60
	FN.200.6	FoodNet Shigella	10	234	10/60
	FN.200.7	FoodNet Vibrio	10	46	10/60
	FN.200.8	FoodNet Yersinia	10	55	10/60
	FN.200.9	FoodNet Hemolytic Uremic Syndrome	10	10	1
	FN.200.10	FoodNet Clinical Laboratory Practices and Testing Volume	10	70	10/60
	FSN.300.1	FluSurv-Net Influenza Hospitalization Surveillance Network Case Report Form	15	576	25/60
	FSN.300.2	FluSurv-Net Influenza Hospitalization Surveillance Project Vaccination Phone Script and Consent Form (English/Spanish)	13	16	10/60
	FSN.300.3	FluSurv-Net Influenza Hospitalization Surveillance Project Provider Vaccination History Fax Form (Children/Adults)and notification letter	13	126	5/60
	FSN.300.4	FluSurv-NET Laboratory Survey	15	16	10/60
	HAIC.400.1	HAIC—Multi-site Gram-Negative Surveillance Initiative (MuGSI) Case Report Form (CRF)	11	1,581	29/60
	HAIC.400.2	HAIC MuGSI CA CP-CRE Health interview	10	10	30/60
	HAIC.400.3	HAIC MuGSI Supplemental Surveillance Officer Survey	11	1	20/60
	HAIC.400.4	HAIC—Invasive Staphylococcus aureus Infection Case Report Form	10	788	29/60
	HAIC.400.5	HAIC—Invasive Staphylococcus aureus Laboratory Survey	10	11	9/60
	HAIC.400.6	HAIC—Invasive Staphylococcus aureus Supplemental Surveillance Officers Survey	10	1	11/60
	HAIC.400.7	HAIC—CDI Case Report and Treatment Form	10	1,650	38/60
	HAIC.400.8	HAIC—Annual Survey of Laboratory Testing Practices for C. difficile Infections	10	16	17/60
	HAIC.400.9	HAIC—CDI Annual Surveillance Officers Survey	10	1	15/60
	HAIC.400.10	HAIC—Emerging Infections Program C. difficile Surveillance Nursing Home Telephone Survey (LTCF)	10	45	5/60
	HAIC.400.11	HAIC Candidemia Case Report Form	10	170	40/60
	HAIC.400.12	HAIC—Laboratory Testing Practices for Candidemia Questionnaire	10	20	14/60
	HAIC.400.13	HAIC Death Ascertainment Project	10	8	24