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Form Approved OMB No. 09200852 Exp. Date 12/31/2016HAI & ANTIMICROBIAL USE PREVALENCE SURVEY PATIENT INFORMATION FORM CDC ID:/Survey date:If data collected on survey date, enter data collection time:
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How to fill out voluntary selfidentification of disability

How to fill out voluntary selfidentification of disability
01
Obtain the voluntary self-identification form from the relevant institution or organization.
02
Read the instructions and guidelines provided on the form carefully.
03
Fill in your personal details such as name, contact information, and any other required information.
04
When asked about disability status, check the appropriate box or provide any necessary information.
05
Review the form for accuracy and completeness before submitting it.
Who needs voluntary selfidentification of disability?
01
Individuals who are applying for jobs, programs, or services provided by organizations that require voluntary self-identification of disability.
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What is voluntary selfidentification of disability?
Voluntary selfidentification of disability is the process where an individual indicates whether they have a disability
Who is required to file voluntary selfidentification of disability?
Federal contractors and subcontractors with 50 or more employees are required to file voluntary selfidentification of disability
How to fill out voluntary selfidentification of disability?
Employees can fill out voluntary selfidentification of disability forms provided by their employer
What is the purpose of voluntary selfidentification of disability?
The purpose of voluntary selfidentification of disability is to track and measure the representation of individuals with disabilities in the workforce
What information must be reported on voluntary selfidentification of disability?
Employees are typically asked to disclose whether they have a disability and, if so, specify the type of disability
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