57.114 Urinary Tract Infection (UTI)

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⚠️ Notice: This information collection may be referencing outdated material.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 CDC 57.114 57.114 Urinary Tract Infection (UTI) Form
CDC 57.114 Urinary Tract Infection (UTI) 57.114_UTI_BLANK.docx Form
Att G.3_Catheter-Associated UTI.pdf Att G.3_Catheter Associated Urinary Tract Infection IC Document

Information Collection (IC) Details

IC Title:	57.114 Urinary Tract Infection (UTI)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	CDC 57.114	Urinary Tract Infection (UTI)	57.114_UTI_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 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	240,000	78,000	162,000
Annual IC Time Burden (Hours)	120,000	41,700	78,300
Annual IC Cost Burden (Dollars)	4,389,440	1,426,568	2,962,872

Documents for IC

Title	Document	Date Uploaded
Att G.3_Catheter Associated Urinary Tract Infection	Att G.3_Catheter-Associated UTI.pdf	08/25/2014

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