Patient Information Form (PIF)

Prevalence Survey of Healthcare Associated Infections (HAIs) and Antimicrobial Use in U.S. Acute Care Hospitals

OMB: 0920-0852

IC ID: 192452

Documents and Forms
Information Collection (IC) Details

View Information Collection (IC)

Patient Information Form (PIF) 0920-0852
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Patient Information Attachment_D_PIF_Final_Updated.pdf Yes No Paper Only

Health Public Health Monitoring

 

100 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 6,300 0 0 0 0 6,300
Annual IC Time Burden (Hours) 1,785 0 0 0 0 1,785
Annual IC Cost Burden (Dollars) 63,118 0 63,118 0 0 0

Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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