57.128 Laboratory Identified or CDI MDRO 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⚠️ Notice: This information collection may be referencing outdated material.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 57.128 57.128 Laboratory Identified or CDI MDRO Event Form
CDC 57.128 Laboratory-identified MDRO or CDI Event 57.128_LabIDEvent_BLANK.DOCX Form
CDC 57.128 Laboratory-identified MDRO or CDI Event 57.128_LabIDEvent_BLANK.DOCX Form
CDC 57.128 Rev 7, Lab ID Event 57.128_LabIDEvent_BLANK.docx Form and Instruction
CDC 57.128 Rev 7, Lab ID Event 57.128_LabIDEvent_BLANK.docx Form and Instruction
G16. MDRO & CDI.pdf Att G16_MDRO & CDI IC Document
G16. MDRO & CDI.pdf Att G16_MDRO & CDI IC Document

Information Collection (IC) Details

IC Title:	57.128 Laboratory Identified or CDI MDRO Event	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 57.128	Laboratory-identified MDRO or CDI Event	57.128_LabIDEvent_BLANK.DOCX		Yes	Yes	Fillable Fileable
Form and Instruction	CDC 57.128 Rev 7, v8.5	Lab ID Event	57.128_LabIDEvent_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: 4,800	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	379,200	379,200
Annual IC Time Burden (Hours)	126,400	126,400
Annual IC Cost Burden (Dollars)	5,013,024	5,013,024

Documents for IC

Title	Document	Date Uploaded
Att G16_MDRO & CDI	G16. MDRO & CDI.pdf	08/01/2016

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