Information Collection

57.114 Urinary Tract Infection (UTI)

IC 183551 under ICR 201708-0920-029 · 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⚠️ Notice: This information collection may be referencing outdated material.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 57.114 57.114 Urinary Tract Infection (UTI) Form
CDC 57.114 Urinary Tract infection (UTI) 57.114_UTI_BLANK.DOCX Form
G4. Catheter Associated Urinary Tract Infection.pdf Att G4_Catheter-Associated Urinary Tract Infection IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	57.114 Urinary Tract Infection (UTI)	Agency IC Tracking Number:	0920-0666

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 Fileable

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	0	240,000
Annual IC Time Burden (Hours)	80,000	0	80,000
Annual IC Cost Burden (Dollars)	3,172,800	-1,216,640	4,389,440

Documents for IC

Title	Document	Date Uploaded
Att G4_Catheter-Associated Urinary Tract Infection	G4. Catheter Associated Urinary Tract Infection.pdf	07/25/2016

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