57.503 Denominators for Outpatient Dialysis

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⚠️ Notice: This information collection may be referencing outdated material.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 57.503 57.503 Denominators for Outpatient Dialysis Form
CDC 57.503 Demominators for Dialysis Event Surveillance 57.503_Denom DE_BLANK.DOCX Form
CDC 57.503 Demominators for Dialysis Event Surveillance 57.503_Denom DE_BLANK.DOCX Form
G9. Dialysis Event.pdf Att G9_Dialysis Event IC Document
G9. Dialysis Event.pdf Att G9_Dialysis Event IC Document

Information Collection (IC) Details

IC Title:	57.503 Denominators for Outpatient Dialysis	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 57.503	Demominators for Dialysis Event Surveillance	57.503_Denom DE_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: 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)	36,000	36,000
Annual IC Cost Burden (Dollars)	1,168,560	1,168,560

Documents for IC

Title	Document	Date Uploaded
Att G9_Dialysis Event	G9. Dialysis Event.pdf	08/01/2016

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