57.120 Surgical Site Infection (SSI)

[NCEZID] 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⚠️ Notice: This information collection may be referencing outdated material.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 57.120 57.120 Surgical Site Infection (SSI) Form
CDC 57.120 Surgical Site Infection 57.120_SSI_BLANK_November_2022.docx Form
CDC 57.120 Surgical Site Infection 57.120_SSI_BLANK_November_2022.docx Form
57.120_SSI_BLANK_November_2022.docx 57.120 Surgical Site Infection with GISAB edits in tracked changes IC Document
57.120_SSI_BLANK_November_2022.docx 57.120 Surgical Site Infection with GISAB edits in tracked changes IC Document

Information Collection (IC) Details

IC Title:	57.120 Surgical Site Infection (SSI)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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 57.120	Surgical Site Infection	57.120_SSI_BLANK_November_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: 6,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	54,000	0	54,000
Annual IC Time Burden (Hours)	32,400	900	31,500
Annual IC Cost Burden (Dollars)	0	-1,249,290	1,249,290

Documents for IC

Title	Document	Date Uploaded
57.120 Surgical Site Infection with GISAB edits in tracked changes	57.120_SSI_BLANK_November_2022.docx	04/25/2023

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