Information Collection

57.507 Home Dialysis Center Practices Survey

IC 222908 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⚠️ Notice: This information collection may be referencing outdated material.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 57.507 57.507 Home Dialysis Center Practices Survey	Form
57.507 57.507 Home Dialysis Center Practices Survey 57.507_HomeDialysisSurv.2021.pdf	Form
57.507 57.507 Home Dialysis Center Practices Survey 57.507_HomeDialysisSurv.2021.pdf	Form
57.507 57.507_dialhomesurv_2020_final 57.507_dialhomesurv_2020_final.pdf	Form and Instruction
57.507 57.507_dialhomesurv_2020_final 57.507_dialhomesurv_2020_final.pdf	Form and Instruction

IC Title:

57.507 Home Dialysis Center Practices Survey

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	57.507	57.507 Home Dialysis Center Practices Survey	57.507_HomeDialysisSurv.2021.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	57.507	57.507_dialhomesurv_2020_final	57.507_dialhomesurv_2020_final.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 450

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	450	20	430
Annual IC Time Burden (Hours)	270	55	215
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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