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Federal forms, ICRs, and supporting documents

Information Collection

57.114 Urinary Tract Infection (UTI)

IC 183551 under ICR 202310-0920-013 · OMB 0920-0666.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

57.114 Urinary Tract Infection (UTI) 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 57.114 Urinary Tract infection (UTI) 57.114_UTI_BLANK_November_2022.docx NA Yes Yes Fillable Fileable

Health Health Care Services

 

6,000 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 30,000 0 0 0 0 30,000
Annual IC Time Burden (Hours) 10,500 0 0 0 0 10,500
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
57.114 UTI form with GISAB edits in tracked changes 57.114_UTI_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.