Information Collection

57.121 Denominators for Procedure

IC 183564 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form CDC 57.121 57.121 Denominators for Procedure	Form
CDC 57.121 Denominatoir for Procedure 57.121_DenomProc_BLANK.docx	Form
G20. Surgical Site Infection.pdf Att G20_Surgical Site Infection	IC Document

IC Title:

57.121 Denominators for Procedure

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 57.121	Denominatoir for Procedure	57.121_DenomProc_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: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	3,240,000	0	3,240,000
Annual IC Time Burden (Hours)	540,000	0	540,000
Annual IC Cost Burden (Dollars)	17,528,400	9,028,800	8,499,600

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att G20_Surgical Site Infection	G20. Surgical Site Infection.pdf	08/03/2016

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