Late Onset Sepsis/Meningitis Denominator Form: Data Table (Monthly)

[NCEZID] The National Healthcare Safety Network (NHSN)

Documents and Forms

Document Name Document Type
Form 57.601 Late Onset Sepsis/Meningitis Denominator Form: Data Table (Monthly) Form and Instruction
57.601 Late Onset Sepsis/ Meningitis Denominator Form: Data Tab 57.601 LOS MEN DenominatorForm-Clean Version.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Late Onset Sepsis/Meningitis Denominator Form: Data Table (Monthly)	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	57.601	Late Onset Sepsis/ Meningitis Denominator Form: Data Table for monthly electronic upload	57.601 LOS MEN DenominatorForm-Clean Version.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 300	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	1,800	1,800
Annual IC Time Burden (Hours)	150	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.