57.125 Central Line Insertion Practices Adherence Monitoring Form

[NCEZID] The National Healthcare Safety Network (NHSN)

Documents and Forms

Document Name Document Type
Form CDC 57.125 57.125 Central Line Insertion Practices Adherence Monitoring Form Form
CDC 57.125 Central Line Insertion Practices Adherence Monitoring 57.125_Central Line Insertion Practices (CLIP).docx Form

Information Collection (IC) Details

IC Title:	57.125 Central Line Insertion Practices Adherence Monitoring Form	Agency IC Tracking Number:

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	CDC 57.125	Central Line Insertion Practices Adherence Monitoring	57.125_Central Line Insertion Practices (CLIP).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 500	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	Previously Approved
Annual Number of Responses for this IC	106,500	106,500
Annual IC Time Burden (Hours)	46,150	46,150
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.