57.142 Denominators for LTCF Locations

The National Healthcare Safety Network (NHSN)

⚠️ Notice: This information collection may be referencing outdated material.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 57.142 57.142 Denominators for LTCF Locations Form
CDC 57.142 Denominators for LTCF 57.142_DenominatorLTCF_BLANK.docx Form
15. LTCF Urinary Tract Infection.pdf Att G15_LTCF Urinary Tract Infection IC Document

Information Collection (IC) Details

IC Title:	57.142 Denominators for LTCF Locations	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 57.142	Denominators for LTCF	57.142_DenominatorLTCF_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: 2,600	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	31,200	0	31,200
Annual IC Time Burden (Hours)	130,000	5,200	124,800
Annual IC Cost Burden (Dollars)	4,949,568	0	4,949,568

Documents for IC

Title	Document	Date Uploaded
Att G15_LTCF Urinary Tract Infection	15. LTCF Urinary Tract Infection.pdf	09/26/2018

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