Information Collection

57.140 NHSN and Secure Access Management Services (SAMS) enrollment

IC 243698 under ICR 202602-0920-005 · OMB 0920-1317.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 57.140 NHSN Registration Form 57.140 NHSN and Secure Access Management Services (SAMS) enrollment	Form and Instruction
57.140 NHSN Registration Form NHSN registration form.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

0920-20LW

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	57.140				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 11,500

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 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	11,500	11,500
Annual IC Time Burden (Hours)	958	958
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.

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