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⚠️ Notice: This information collection may be referencing outdated material.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

	Requested	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.