57.114 Urinary Tract Infection (UTI)

[NCEZID] The National Healthcare Safety Network (NHSN)

Documents and Forms

Document Name Document Type
Form 57.114 57.114 Urinary Tract Infection (UTI) Form and Instruction
57.114 Urinary Tract infection (UTI) 57.114 Urinary Tract infection (UTI)_Clean Version.docx Form and Instruction

Information Collection (IC) Details

IC Title:	57.114 Urinary Tract Infection (UTI)	Agency IC Tracking Number:	0920-0666

Is this a Common Form? No		IC Status: Modified

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 and Instruction	57.114	Urinary Tract infection (UTI)	57.114 Urinary Tract infection (UTI)_Clean Version.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6,000	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	72,000	42,000	30,000
Annual IC Time Burden (Hours)	28,800	18,300	10,500
Annual IC Cost Burden (Dollars)	0	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.