Information Collection

57.126 MDRO or CDI Infection Event

IC 183561 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form CDC 57.126 57.126 MDRO or CDI Infection Event Form
CDC 57.126 MDRO or CDI Infection Event 57.126_MDROInfectionEvent_BLANK.docx Form
Att G.14_MDRO CDI.pdf Att G.14 Multidrug-Resistant Organism & Clostridium difficile Infection (MDRO/CDI) Module IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	57.126 MDRO or CDI Infection Event	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 57.126	MDRO or CDI Infection Event	57.126_MDROInfectionEvent_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	432,000	0	432,000
Annual IC Time Burden (Hours)	216,000	7,200	208,800
Annual IC Cost Burden (Dollars)	7,900,992	0	7,900,992

Documents for IC

Title	Document	Date Uploaded
Att G.14 Multidrug-Resistant Organism & Clostridium difficile Infection (MDRO/CDI) Module	Att G.14_MDRO CDI.pdf	08/25/2014

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