57.121 Denominators for Procedure

[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⚠️ Notice: This information collection may be referencing outdated material.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 57.121 57.121 Denominators for Procedure Form and Instruction
57.121 Denominator for Procedure 57.121_DenomProc_November_2022.docx Form and Instruction
57.121 Denominator for Procedure 57.121_DenomProc_November_2022.docx Form and Instruction
57.121_DenomProc_November_2022.docx 57.121 Denominators for Procedure with GISAB edits in tracked changes IC Document
57.121_DenomProc_November_2022.docx 57.121 Denominators for Procedure with GISAB edits in tracked changes IC Document

Information Collection (IC) Details

IC Title:	57.121 Denominators for Procedure	Agency IC Tracking Number:	0920-0666

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 and Instruction	57.121	Denominator for Procedure	57.121_DenomProc_November_2022.docx	NA	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	3,612,000	0	3,612,000
Annual IC Time Burden (Hours)	662,200	60,200	602,000
Annual IC Cost Burden (Dollars)	0	-19,540,920	19,540,920

Documents for IC

Title	Document	Date Uploaded
57.121 Denominators for Procedure with GISAB edits in tracked changes	57.121_DenomProc_November_2022.docx	04/25/2023

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