57.139 MDRO and CDI Prevention Process Measures Monthly 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⚠️ Notice: This information collection may be referencing outdated material.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 57.139 57.139 MDRO and CDI Prevention Process Measures Monthly for LTCF Form
CDC 57.139 MDRO and CDI Prevention Process Measures Monthly Monitor 57.139_MDROMonthlyReporting_LTCF_BLANK.docx Form
CDC 57.139 MDRO and CDI Prevention Process Measures Monthly Monitor 57.139_MDROMonthlyReporting_LTCF_BLANK.docx Form
14. LTCF Prevention Process Measures.pdf Att G14_LTCF MDRO CDI IC Document
14. LTCF Prevention Process Measures.pdf Att G14_LTCF MDRO CDI IC Document

Information Collection (IC) Details

IC Title:	57.139 MDRO and CDI Prevention Process Measures Monthly 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 57.139	MDRO and CDI Prevention Process Measures Monthly Monitoring for LTCF	57.139_MDROMonthlyReporting_LTCF_BLANK.docx		Yes	Yes	Fillable Printable

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	23,976	23,976
Annual IC Time Burden (Hours)	7,992	7,992
Annual IC Cost Burden (Dollars)	158,481	158,481

Documents for IC

Title	Document	Date Uploaded
Att G14_LTCF MDRO CDI	14. LTCF Prevention Process Measures.pdf	09/26/2018

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