Information Collection

57.120 Surgical Site Infection (SSI)

IC 183562 under ICR 202102-0920-011 · 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⚠️ Notice: This information collection may be referencing outdated material.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 57.120 57.120 Surgical Site Infection (SSI) Form
CDC 57.120 Surgical site infection COVID-19_FieldAddition_57.120_SSI_BLANK.docx Form
G20. Surgical Site Infection.pdf Att G20_Surgical Site Infection IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	57.120 Surgical Site Infection (SSI)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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 57.120	Surgical site infection	COVID-19_FieldAddition_57.120_SSI_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: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	54,000	54,000
Annual IC Time Burden (Hours)	31,500	31,500
Annual IC Cost Burden (Dollars)	1,249,290	1,249,290

Documents for IC

Title	Document	Date Uploaded
Att G20_Surgical Site Infection	G20. Surgical Site Infection.pdf	08/01/2016

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