Information Collection

Baseline Infection Rate Summary

IC 185568 under ICR 200807-0935-001 · OMB 0935-0144.

Documents and Forms

Document Name Document Type
Form Form #3 Baseline Infection Rate Summary Form
Form #3 Baseline Infection Rate Summary Attachment D -- Baseline Infection Rates Summary Instrument.doc Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Baseline Infection Rate Summary	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
Form	Form #3	Baseline Infection Rate Summary	Attachment D -- Baseline Infection Rates Summary Instrument.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 34	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	34	34
Annual IC Time Burden (Hours)	17	17
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.