Information Collection

57.114 Urinary Tract Infection (UTI)

IC 183551 under ICR 202006-0920-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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 57.114 57.114 Urinary Tract Infection (UTI)	Form
CDC 57.114 Urinary tract infection COVID-19_FieldAddition_57.114_UTI_BLANK.docx	Form
4. Catheter Associated Urinary Tract Infection.pdf Att G4_Catheter-Associated Urinary Tract Infection	IC Document

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:

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 57.114	Urinary tract infection	COVID-19_FieldAddition_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: 5,500

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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	27,500	0	27,500
Annual IC Time Burden (Hours)	9,625	458	9,167
Annual IC Cost Burden (Dollars)	363,550	0	363,550

Documents for IC

table that charts IC Documents
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.