Information Collection

57.116 Denominators for Neonatal Intensive Care Unit (NICU)

IC 183554 under ICR 202310-0920-013 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form CDC 57.116 57.116 Denominators for Neonatal Intensive Care Unit (NICU)	Form
CDC 57.116 PedVAE Optional Denominators Neonatal Intensive Care Uni 57.116_DenominatorNICU_BLANK.docx	Form
CDC 57.116 PedVAE Optional Denominators Neonatal Intensive Care Uni 57.116_DenominatorNICU_BLANK.docx	Form
8. Denominators for Patient Safety Component.pdf Att G7_Demoninators for Patient Safety Component	IC Document
8. Denominators for Patient Safety Component.pdf Att G7_Demoninators for Patient Safety Component	IC Document

IC Title:

57.116 Denominators for Neonatal Intensive Care Unit (NICU)

Agency IC Tracking Number:

0920-0666

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CDC 57.116	PedVAE Optional Denominators Neonatal Intensive Care Unit (NICU)	57.116_DenominatorNICU_BLANK.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: 1,100

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	13,200	13,200
Annual IC Time Burden (Hours)	880	880
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att G7_Demoninators for Patient Safety Component	8. Denominators for Patient Safety Component.pdf	09/25/2018

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