Information Collection

57.405 Outpatient Procedure Component - Surgical Site Infection (SSI) Event

IC 228154 under ICR 202212-0920-013 · 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⚠️ Notice: This information collection may be referencing outdated material.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 57.404 57.405 Outpatient Procedure Component - Surgical Site Infection (SSI) Event Form
Form 57.404 57.405 Outpatient Procedure Component - Surgical Site Infection (SSI) Event Form
57.404 Outpatient Procedure Component - SSI Denominators 57.405_OPC_SSIEvent_BLANK.DOCX Form
57.404 Outpatient Procedure Component - SSI Denominators 57.405_OPC_SSIEvent_BLANK.DOCX Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	57.405 Outpatient Procedure Component - Surgical Site Infection (SSI) Event	Agency IC Tracking Number:

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	57.404	Outpatient Procedure Component - SSI Denominators	57.405_OPC_SSIEvent_BLANK.DOCX		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 700	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	3,500	3,500
Annual IC Time Burden (Hours)	2,333	2,333
Annual IC Cost Burden (Dollars)	80,973	80,973

Documents for IC

Title	Document	Date Uploaded
No associated records found

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