Information Collection

57.108 Primary Bloodstream Infection (BSI)

IC 183545 under ICR 201407-0920-007 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form CDC 57.108 57.108 Primary Bloodstream Infection (BSI)	Form
CDC 57.108 Primary Bloodstreat Infection (BSI) 57.108_PrimaryBSI_BLANK.docx	Form
Att G.4 CLABSI.pdf Att G.4 Central Line-Associated Blood Stream Infection	IC Document

IC Title:

57.108 Primary Bloodstream Infection (BSI)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CDC 57.108	Primary Bloodstreat Infection (BSI)	57.108_PrimaryBSI_BLANK.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 6,000

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: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	264,000	48,000	216,000
Annual IC Time Burden (Hours)	132,000	16,800	115,200
Annual IC Cost Burden (Dollars)	5,327,872	968,704	4,359,168

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att G.4 Central Line-Associated Blood Stream Infection	Att G.4 CLABSI.pdf	08/25/2014

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