57.600 State Health Department Validation Record

The National Healthcare Safety Network (NHSN)

⚠️ Notice: This information collection may be referencing outdated material.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 57.600 57.600 State Health Department Validation Record Form
57.600 State Health Department Validation Record 57.600_State HD Validation Record_BLANK.DOCX Form
15. State Validation Record.pdf 15 IC Document

Information Collection (IC) Details

IC Title:	57.600 State Health Department Validation Record	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	57.600	State Health Department Validation Record	57.600_State HD Validation Record_BLANK.DOCX		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 152	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	7,600	7,600
Annual IC Time Burden (Hours)	1,900	1,900
Annual IC Cost Burden (Dollars)	59,622	59,622

Documents for IC

Title	Document	Date Uploaded
15	15. State Validation Record.pdf	08/22/2013

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.