57.502 Dialysis Event

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⚠️ Notice: This information collection may be referencing outdated material.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 57.502 57.502 Dialysis Event Form
CDC 57.502 Dialysis Event 57.502_Dial_event_2021_Final Draft for OMB_23March2020.docx Form
CDC 57.502 Dialysis Event 57.502_Dial_event_2021_Final Draft for OMB_23March2020.docx Form
9. Dialysis Event.pdf Att G9.Dialysis Event IC Document
9. Dialysis Event.pdf Att G9.Dialysis Event IC Document

Information Collection (IC) Details

IC Title:	57.502 Dialysis Event	Agency IC Tracking Number:	0920-0666

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 57.502	Dialysis Event	57.502_Dial_event_2021_Final Draft for OMB_23March2020.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 7,200	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	Previously Approved
Annual Number of Responses for this IC	216,000	216,000
Annual IC Time Burden (Hours)	90,000	90,000
Annual IC Cost Burden (Dollars)	2,920,536	2,920,536

Documents for IC

Title	Document	Date Uploaded
Att G9.Dialysis Event	9. Dialysis Event.pdf	09/24/2018

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