Long Term Care Facility Component - Respiratory Tract Infection

[NCEZID] The National Healthcare Safety Network (NHSN)

Documents and Forms

Document Name Document Type
Form 57.602 Long Term Care Facility Component - Respiratory Tract Infection Form and Instruction
57.602 Long-Term Care Facility Component – Respiratory Tract In 57.602 LOS_MEN Event Form-Clean Version.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Long Term Care Facility Component - Respiratory Tract Infection	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	57.602	Long-Term Care Facility Component – Respiratory Tract Infection	57.602 LOS_MEN Event Form-Clean Version.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 300	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,800	0	1,800
Annual IC Time Burden (Hours)	180	30	150
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.