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⚠️ Notice: This information collection may be referencing outdated material.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
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

Information Collection (IC) Details

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

Is this a Common Form? No		IC Status: Unchanged

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: 3,800	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	45,600	45,600
Annual IC Time Burden (Hours)	27,360	27,360
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.