57.151 Patient Safety Component -- Annual Facility Survey for IRF

[NCEZID] The National Healthcare Safety Network (NHSN)

Documents and Forms

Document Name Document Type
Form 57.151 57.151 Patient Safety Component -- Annual Facility Survey for IRF Form and Instruction
57.151 Patient Safety Component—Annual Facility Survey for IRF 57.151_REHAB Annual Facility Survey_2024-Clean Version.docx Form and Instruction

Information Collection (IC) Details

IC Title:	57.151 Patient Safety Component -- Annual Facility Survey for IRF	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	57.151	Patient Safety Component—Annual Facility Survey for IRF	57.151_REHAB Annual Facility Survey_2024-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: 395	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	395	-765	1,160
Annual IC Time Burden (Hours)	672	-1,049	1,721
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.