57.501 Dialysis Monthly Reporting Plan

[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⚠️ Notice: This information collection may be referencing outdated material.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 57.501 57.501 Dialysis Monthly Reporting Plan Form
Form CDC 57.501 57.501 Dialysis Monthly Reporting Plan Form
CDC 57.501 NHSN Registration Form 57.501_DialReportPlan_BLANK_2021_final draft for omb.docx Form
CDC 57.501 NHSN Registration Form 57.501_DialReportPlan_BLANK_2021_final draft for omb.docx Form

Information Collection (IC) Details

IC Title:	57.501 Dialysis Monthly Reporting Plan	Agency IC Tracking Number:	0920-0666

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 57.501	NHSN Registration Form	57.501_DialReportPlan_BLANK_2021_final draft for omb.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 7,400	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	88,800	88,800
Annual IC Time Burden (Hours)	7,400	7,400
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.