Information Collection

57.114 Urinary Tract Infection (UTI)

IC 183551 under ICR 201808-0920-011 · 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⚠️ Notice: This information collection may be referencing outdated material.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
4. 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: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	240,000	240,000
Annual IC Time Burden (Hours)	80,000	80,000
Annual IC Cost Burden (Dollars)	3,172,800	3,172,800

Documents for IC

Title	Document	Date Uploaded
Att G4_Catheter-Associated Urinary Tract Infection	4. Catheter Associated Urinary Tract Infection.pdf	09/25/2018

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