57.138 Laboratory-Identified MDRO or CDI Event for LTCF

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⚠️ Notice: This information collection may be referencing outdated material.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 57.138 57.138 Laboratory-Identified MDRO or CDI Event for LTCF Form
CDC 57.138 Laboratory-identified MDRO or CDI Event for LTCF 57.138_LabIDEvent_LTCF_BLANK.docx Form
CDC 57.138 Laboratory-identified MDRO or CDI Event for LTCF 57.138_LabIDEvent_LTCF_BLANK.docx Form
G13. LTCF MDRO CDI.pdf Att G13_LTCF MDRO CDI IC Document
G13. LTCF MDRO CDI.pdf Att G13_LTCF MDRO CDI IC Document

Information Collection (IC) Details

IC Title:	57.138 Laboratory-Identified MDRO or CDI Event for LTCF	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 57.138	Laboratory-identified MDRO or CDI Event for LTCF	57.138_LabIDEvent_LTCF_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: 1,998	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	47,952	47,952
Annual IC Time Burden (Hours)	9,590	9,590
Annual IC Cost Burden (Dollars)	633,925	633,925

Documents for IC

Title	Document	Date Uploaded
Att G13_LTCF MDRO CDI	G13. LTCF MDRO CDI.pdf	08/08/2016

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