57.507 Home Dialysis Center Practices Survey

[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⚠️ Notice: This information collection may be referencing outdated material.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 57.507 57.507 Home Dialysis Center Practices Survey Form
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

Information Collection (IC) Details

IC Title:	57.507 Home Dialysis Center Practices Survey	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	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 %

	Approved	Previously Approved
Annual Number of Responses for this IC	450	450
Annual IC Time Burden (Hours)	270	270
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.