57.106 Patient Safety Monthly Reporting Plan

[NCEZID] The National Healthcare Safety Network (NHSN)

Documents and Forms

Document Name Document Type
Form 57.106 57.106 Patient Safety Monthly Reporting Plan Form and Instruction
57.106 Patient Safety Monthly Reporting Plan 57.106 Patient Safety Monthly Reporting Plan-Clean Version.docx Form and Instruction

Information Collection (IC) Details

IC Title:	57.106 Patient Safety Monthly Reporting Plan	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	57.106	Patient Safety Monthly Reporting Plan	57.106 Patient Safety Monthly Reporting Plan-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: 7,821	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	93,852	93,852
Annual IC Time Burden (Hours)	23,463	23,463
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.