Patient Information Form (PIF)

Prevalence Survey of Healthcare Associated Infections (HAIs) and Antimicrobial Use in U.S. Acute Care Hospitals

OMB: 0920-0852

IC ID: 192452

Information Collection (IC) Details

View Information Collection (IC)

Patient Information Form (PIF)
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Patient Information Form AttachmentE_FINAL_0920-0852_PIF_20130618.docx Yes No Fillable Printable

Health Public Health Monitoring

 

500 0
   
Private Sector Not-for-profit institutions
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 21,000 0 21,000 0 0 0
Annual IC Time Burden (Hours) 5,950 0 5,950 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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