57.121 Denominators for Procedure

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⚠️ Notice: This information collection may be referencing outdated material.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 57.121 57.121 Denominators for Procedure Form
CDC 57.121 Denominatoir for Procedure 57.121_DenomProc_BLANK.docx Form
CDC 57.121 Denominatoir for Procedure 57.121_DenomProc_BLANK.docx Form
20. Surgical Site Infection.pdf Att G20_Surgical Site Infection IC Document
20. Surgical Site Infection.pdf Att G20_Surgical Site Infection IC Document

Information Collection (IC) Details

IC Title:	57.121 Denominators for Procedure	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 57.121	Denominatoir for Procedure	57.121_DenomProc_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: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	3,612,000	3,612,000
Annual IC Time Burden (Hours)	602,000	602,000
Annual IC Cost Burden (Dollars)	19,540,920	19,540,920

Documents for IC

Title	Document	Date Uploaded
Att G20_Surgical Site Infection	20. Surgical Site Infection.pdf	09/25/2018

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