Information Collection

57.125 Central Line Insertion Practices Adherence Monitoring Form

IC 183555 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⚠️ Notice: This information collection may be referencing outdated material.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 57.125 57.125 Central Line Insertion Practices Adherence Monitoring Form	Form
CDC 57.125 Central Line Insertion Practices Adherence Monitoring 57.125_CLIP_BLANK.docx	Form
Att G.5_CLIP Adherence Monitoring.pdf Att G.5_ Entral Line Insertion Practices (CLIP) Adherence Monitoring	IC Document

IC Title:

57.125 Central Line Insertion Practices Adherence Monitoring Form

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 57.125	Central Line Insertion Practices Adherence Monitoring	57.125_CLIP_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: 1,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	100,000	100,000
Annual IC Time Burden (Hours)	8,333	8,333
Annual IC Cost Burden (Dollars)	315,333	315,333

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att G.5_ Entral Line Insertion Practices (CLIP) Adherence Monitoring	Att G.5_CLIP Adherence Monitoring.pdf	08/25/2014

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