Information Collection

57.108 Primary Bloodstream Infection (BSI)

IC 183545 under ICR 202112-0920-014 · OMB 0920-0666.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0666 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 57.108 57.108 Primary Bloodstream Infection (BSI)	Form and Instruction
57.108 57.108 Primary Bloodstream Infection (BSI) 57.108_PrimaryBSI.2021.pdf_2021.pdf	Form and Instruction
57.108 57.108_PrimaryBSI_BLANK_2022 57.108_PrimaryBSI_BLANK_2022.docx	Form and Instruction
5. Central Line Associated Bloodstream Infection.pdf Att G5_Central Line-Associated Urinary Tract Infection	IC Document
5. Central Line Associated Bloodstream Infection.pdf Att G5_Central Line-Associated Urinary Tract Infection	IC Document

IC Title:

57.108 Primary Bloodstream Infection (BSI)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	57.108	57.108_PrimaryBSI_BLANK_2022	57.108_PrimaryBSI_BLANK_2022.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,775

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 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	28,875	28,875
Annual IC Time Burden (Hours)	18,288	18,288
Annual IC Cost Burden (Dollars)	572,591	572,591

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att G5_Central Line-Associated Urinary Tract Infection	5. Central Line Associated Bloodstream Infection.pdf	09/16/2019

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