57.104 NHSN Administrator Change Request Form

[NCEZID] The National Healthcare Safety Network (NHSN)

OMB: 0920-0666

IC ID: 237430

Information Collection (IC) Details

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57.104 NHSN Administrator Change Request Form 0920-0666
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction none Facility Administrator Change Request 57.104_FAChangeRequest_BLANK 020521 clean.docx Yes Yes Fillable Fileable

Health Health Care Services

 

800 0
   
State, Local, and Tribal Governments
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 800 0 0 0 0 800
Annual IC Time Burden (Hours) 67 0 0 0 0 67
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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