Information Collection

57.120 Surgical Site Infection (SSI)

IC 183562 under ICR 202412-0920-018 · OMB 0920-0666.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0666 can be found here:

Documents and Forms

Document Name Document Type
Form CDC 57.120 57.120 Surgical Site Infection (SSI) Form
CDC 57.120 Surgical Site Infection 57.120 SSI-Clean Version.docx Form
CDC 57.120 Surgical Site Infection 57.120 SSI-Clean Version.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	57.120 Surgical Site Infection (SSI)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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 57.120	Surgical Site Infection	57.120 SSI-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: 3,800	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	45,600	45,600
Annual IC Time Burden (Hours)	10,640	10,640
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.