Information Collection

57.139 MDRO and CDI Prevention Process Measures Monthly Monitoring for LTCF

IC 197543 under ICR 201105-0920-001 · OMB 0920-0666.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0666 can be found here:

Documents and Forms

Document Name Document Type
Form 57.139 57.139 MDRO and CDI Prevention Process Measures Monthly Monitoring for LTCF Form
57.139 MDRO and CDI Prevention Process Measures Monthly Monitor 57.139_MDROMonthlyReporting_LTCF_BLANK.ppt Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	57.139 MDRO and CDI Prevention Process Measures Monthly Monitoring for LTCF	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	57.139	MDRO and CDI Prevention Process Measures Monthly Monitoring for LTCF	57.139_MDROMonthlyReporting_LTCF_BLANK.ppt		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 250	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	750	750
Annual IC Time Burden (Hours)	88	88
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.