Information Collection

57.118 Denominators for Intensive Care Unit (ICU) Other Locations (Not NICU or SCA)

IC 183558 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form CDC 57.118 57.118 Denominators for Intensive Care Unit (ICU) Other Locations (Not NICU or SCA) Form
CDC 57.118 Denominators for Intensive Care Unit (ICU)/Other locatio 57.118_DenominatorICU_BLANK.DOCX Form
CDC 57.118 Denominators for Intensive Care Unit (ICU)/Other locatio 57.118_DenominatorICU_BLANK.DOCX Form
G8. Denominators for Patient Safety Component.pdf Att G8_Denominators for Patient Safety Component IC Document
G8. Denominators for Patient Safety Component.pdf Att G8_Denominators for Patient Safety Component IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	57.118 Denominators for Intensive Care Unit (ICU) Other Locations (Not NICU or SCA)	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 57.118	Denominators for Intensive Care Unit (ICU)/Other locations (not NICU or SCA)	57.118_DenominatorICU_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: 5,500	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	330,000	330,000
Annual IC Time Burden (Hours)	27,500	27,500
Annual IC Cost Burden (Dollars)	53,757,000	53,757,000

Documents for IC

Title	Document	Date Uploaded
Att G8_Denominators for Patient Safety Component	G8. Denominators for Patient Safety Component.pdf	07/25/2016

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