[NCEZID] The National Healthcare Safety Network (NHSN)

OMB 0920-0666

The National Healthcare Safety Network (NHSN) is a system designed to accumulate, exchange, and integrate relevant information and resources among private and public stakeholders to support local and national efforts to protect patients and promote healthcare safety. Specifically, the data is used to determine the magnitude of various healthcare-associated adverse events and trends in the rates of these events among patients and healthcare workers with similar risks. The data will be used to detect changes in the epidemiology of adverse events resulting from new and current medical therapies and changing risks.

The latest form for [NCEZID] The National Healthcare Safety Network (NHSN) expires 2023-12-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form 57.106 57.106 Patient Safety Monthly Reporting Plan Form and Instruction
Form 57.803 All Hazards Form and Instruction
Form 57.802 Bed Capacity-IT Initial Set Up Form and Instruction
Form 57.801 External Validation Summary Report Form and Instruction
Form 57.215 Seasonal Survey on Influenza Vaccination Programs for Healthcare Personnel Form and Instruction
Form 57.214 Annual Healthcare Personnel Influenza Vaccination Summary (CSV) Form
Form 57.211 Weekly Healthcare Personnel Influenza Vaccination Cumulative Summary for Non-Long-Term Care Facilities (CSV) Form
Form 57.133 Patient Safety Attestation Form and Instruction
Form 57.130 Pathogens of High Consequence Form and Instruction
Form 57.124 AUR Pharmacy Data Electronic Upload Specification Tables (Yearly Maintenance) Form
Form 57.124 AUR Pharmacy Data Electronic Upload Specification Tables (Initial Set-up) Form
Form 57.123 AUR Microbiolgy Data Electronic Upload Specification Tables (Yearly Maintenance) Form
Form 57.123 AUR Microbiology Data Electronic Upload Specification Tables (Initial Set-up) Form
Form 57.102 NHSN Help Desk Customer Satisfaction Survey Form and Instruction
Form CDC 57.302 Hemovigilance Module Monthly Incident Summary Form and Instruction
Form 57.800 Billing Code Data: 837I Upload Form
Form 57.701 57.701 - Glycemic Control Module-HYPO Annual Survey Form and Instruction
Form 57.700 57.700 - Medication Safety Component FHIR Measure-Glycemic Control Module Hypoglycemia-Infection Preventionist Form and Instruction
Form 57.700 57.700 - Medication Safety Component FHIR Measure-Glycemic Control Module Hypoglycemia-IT Yearly Maintenance Form and Instruction
Form 57.700 57.700 - Medication Safety Component FHIR Measure-Glycemic Control Module Hypoglycemia-IT Initial Set up Form and Instruction
Form 57.600 57.600 - Neonatal Component Late Onset Sepsis Meningitis (LOSMEN) Module CDA Data Collection-Infection Preventionist Form and Instruction
Form 57.600 57.600 - Neonatal Component FHIR Measure-Late Onset Sepsis Meningitis (LOSMEN) Module-Infection Preventionist Form and Instruction
Form 57.600 57.600 - Neonatal Component FHIR Measure-Late Onset Sepsis Meningitis (LOSMEN) Module-IT Yearly Maintenance Form and Instruction
Form 57.600 57.600 - Neonatal Component FHIR Measure-Late Onset Sepsis Meningitis (LOSMEN) Module-IT Initial Set up Form and Instruction
Form 57.145 57.145 - Long Term Care Antimicrobial Use (LTC-AU) Module CDA Form and Instruction
Form 57.144 57.144 - Long Term Care Respiratory Tract Infections (RTI) Module Form and Instruction
Form 57.133 57.133 - Patient Safety Component FHIR Measures-VTE Module- Infection Preventionist Form and Instruction
Form 57.133 57.133 - Patient Safety Component FHIR Measures-VTE Module-IT Yearly Maintenance Form and Instruction
Form 57.133 57.133 - Patient Safety Component FHIR Measures-VTE Module-IT Initial Set up Form and Instruction
Form 57.132 57.132 - Patient Safety Component FHIR Measures-HOB, HT-CDI Modules-Infection Preventionist Form and Instruction
Form 57.132 57.132 - Patient Safety Digital Reporting Plan (RPS CSV) Form and Instruction
Form 57.130 57.130 - Patient Safety Component FHIR Measure Respiratory Pathogens Surveillance (RPS)-Infection Preventionist Form and Instruction
Form 57.130 57.130 - Patient Safety Component FHIR Measure Respiratory Pathogens Surveillance (RPS) - IT Yearly Maintenance Form and Instruction
Form 57.130 57.130 Patient Safety Component FHIR Measure Respiratory Pathogens Surveillance (RPS) - IT Initial Set up Form and Instruction
Form 57.408 Monthly Survey Patient Days & Nurse Staffing Form and Instruction
Form CDC 57.214 Annual Healthcare Personnel Influenza Vaccination Summary (manual) Form and Instruction
Form 0920-0666 Weekly Resident Influenza Vaccination Cumulative Summary for Long-Term Care Facilities Form and Instruction
Form 0920-0666 Weekly Healthcare Personnel Influenza Vaccination Cumulative Summary for Long-Term Care Facilities Form and Instruction
Form CDC 57.211 Weekly Healthcare Personnel Influenza Vaccination Cumulative Summary for Non-Long-Term Care Facilities Form and Instruction
Form 57.601 Late Onset Sepsis/Meningitis Denominator Form: Data Table (Monthly) Form and Instruction
Form 57.602 Long Term Care Facility Component - Respiratory Tract Infection Form and Instruction
57.104 NHSN Administrator Change Request Form Form and Instruction
Form CDC 55.122 57.122 HAI Progress Report State Health Department Survey Form
Form CDC 57.405 57.405 Outpatient Procedure Component - Surgical Site Infection (SSI) Event Form
Form 57.404 57.404 Outpatient Procedure Component - SSI Denominators Form
Form 57.507 57.507 Home Dialysis Center Practices Survey Form
Form 57.320 57.320 Hemovigilance Adverse Reaction - Other Transfusion Reaction Form
Form CDC 57.319 57.319 Hemovigilance Adverse Reaction - Unknown Transfusion Reaction Form
Form CDC 57.318 57.318 Hemovigilance Adverse Reaction - Transfusion Associated Circulatory Overload Form
Form 57.317 57.317 Hemovigilance Adverse Reaction - Transfusion Associated Acute Lung Injury Form
Form CDC 57.316 57.316 Hemovigilance Adverse Reaction - Transfusion Associated Graft vs. Host Disease Form
Form CDC 57.315 57.315 Hemovigilance Adverse Reaction - Transfusion Associated Dyspnea Form
Form 57.314 57.314 Hemovigilance Adverse Reaction - Post Transfusion Purpura Form
Form 57.313 57.313 Hemovigilance Adverse Reaction - Infection Form
Form 57.312 57.312 Hemovigilance Adverse Reaction - Hypotensive Transfusion Reaction Form
Form CDC 57.311 57.311 Hemovigilance Adverse Reaction - Febrile Non-hemolytic Transfusion Reaction Form
Form 57.310 57.310 Hemovigilance Adverse Reaction - Delayed Serologic Transfusion Reaction Form
Form CDC 57.309 57.309 Hemovigilance Adverse Reaction - Delayed Hemolytic Transfusion Reaction Form
Form 57.308 57.308 Hemovigilance Adverse Reaction - Allergic Transfusion Reaction Form
Form 57.307 57.307 Hemovigilance Adverse Reaction - Acute Hemolytic Transfusion Reaction Form
Form 57.306 57.306 Hemovigilance Module Annual Facility Survey - Non-acute Care Facility Form
Form 57.129 57.129_Adult Sepsis Form
Form CDC 57.115 57.115 Custom Event Form
Form 57.113 57.113 Pediatric Ventilator-Associated Event (PedVAE) Form and Instruction
Form CDC 57.506 57.506 Dialysis Patient Influenza Vaccination Denominator Form
Form CDC 57.505 57.505 Dialysis Patient Influenza Vaccination Form
Form CDC 57.504 57.504 Prevention Process Measures Monthly Monitoring for Dialysis Form
Form CDC 57.501 57.501 Dialysis Monthly Reporting Plan Form
Form CDC 57.403 57.403 Outpatient Procedure Component - Monthly Denominators and Summary Form
Form CDC 57.402 57.402 Outpatient Procedure Component Event Form
Form CDC 57.401 57.401 Outpatient Procedure - Monthly Reporting Plan Form
Form CDC 57.400 57.400 Outpatient Procedure - Annual Facility Survey Form
Form 57.151 57.151 Patient Safety Component -- Annual Facility Survey for IRF Form and Instruction
Form 57.150 57.150 Patient Safety Component -- Annual Facility Survey for LTAC Form and Instruction
Form CDC 57.143 57.143 Prevention Process Measures Monthly Monitoring for LTCF Form
Form CDC 57.142 57.142 Denominators for LTCF Locations Form
Form CDC 57.141 57.141 Monthly Reporting Plan for LTCF Form
Form 57.112 57.112 Ventilator-Associated Event (VAE) Form and Instruction
Form CDC 57.139 57.139 MDRO and CDI Prevention Process Measures Monthly for LTCF Form
Form CDC 57.138 57.138 Laboratory-Identified MDRO or CDI Event for LTCF Form
Form CDC 57.137 57.137 Long Term care Facility Component--Annual Facility Survey Form
Form CDC 57.305 57.305 Hemovigilance Incident Form
Form CDC 57.303 57.303 Hemovigilance Module Monthly Reporting Denominators Form and Instruction
Form 57.301 57.301 Hemovigilance Module Monthly Reporting Plan Form and Instruction
Form CDC 57.300 57.300 Hemovigilance Module Annual Survey -- Acute Care Facility Form
Form CDC 57.200 57.200 Healthcare Personnel Safety Component Facility Survey Form
Form CDC 57.204 57.204 Healthcare Worker Demographic Data Form
Form CDC 57.206 57.206 Healthcare Worker Prophylaxis/Treatment Form
Form CDC 57.205 57.205 Exposure to Blood and Body Fluids Form
Form CDC 57.105 57.105 Group Contact Information Form
Form 57.140 57.140 Urinary Tract Infection (UTI) for LTCF Form and Instruction
Form 57.103 57.103 Patient Safety Component - Annual Hospital Survey Form and Instruction
Form CDC 57.101 57.101 Facility Contact Information Form
Form 57.124 57.124 Antimicrobial Use and Resistence (AUR) - Pharmacy Data Form and Instruction
Form 57.123 57.123 Antimicrobial Use and Resistance (AUR) - Microbiology Data Upload Tables Form and Instruction
Form CDC 57.100 57.100 NHSN Registration Form Form
Form 57.121 57.121 Denominators for Procedure Form and Instruction
Form 57.128 57.128 Laboratory Identified or CDI MDRO Event Form
Form CDC 57.120 57.120 Surgical Site Infection (SSI) Form
Form CDC 57.126 57.126 MDRO or CDI Infection Event Form
Form CDC 57.503 57.503 Denominators for Outpatient Dialysis Form
Form CDC 57.127 57.127 MDRO and CDI Prevention Process and Outcome Measures Monthly Monitoring Form
Form CDC 57.118 57.118 Denominators for Intensive Care Unit (ICU) Other Locations (Not NICU or SCA) Form
Form CDC 57.207 57.207 Follow-up Laboratory Testing Form
Form CDC 57.117 57.117 Denominators for Specialty Care Area (SCA)/Onocology (ONC) Form
Form CDC 57.125 57.125 Central Line Insertion Practices Adherence Monitoring Form Form
Form CDC 57.116 57.116 Denominators for Neonatal Intensive Care Unit (NICU) Form
Form 57.114 57.114 Urinary Tract Infection (UTI) Form and Instruction
Form CDC 57.210 57.210 Healthcare Worker Prophylaxis/Treatment - Influenza Form
Form 57.111 57.111 Pneumonia (includes Any Patient Pneumonia flow Diagram and Infant and Children Pneumonia Flow Diagram) Form and Instruction
Form CDC 57.502 57.502 Dialysis Event Form and Instruction
Form 57.108 57.108 Primary Bloodstream Infection (BSI) Form and Instruction
Form 57.500 57.500 Outpatient Dialysis Center Practices Survey Form and Instruction
Form CDC 57.203 57.203 Healthcare Personnel Safety Reporting Plan Form
2025 OMB FHIR RPS Data Dictionary_Updated_8_23_2024.xlsx Supplementary Document
2025 OMB FHIR ACH Monthly Measures Data Dictionary_8_23_2024.xlsx Supplementary Document
G3. Privacy Impact Assessment_NHSN_PIA_Signed_2023-01-19.pdf Supplementary Document
G2. Privacy Impact Assessment_ NHSN2-Cloud_PIA_Signed_2023-12-05_eRAP.pdf Supplementary Document
G1. Privacy Impact Assessment.pdf Supplementary Document
F2. NHSN 308d Request for Extension and Ammendment.docx Supplementary Document
F1. NHSN 308d Approval 2015.pdf Supplementary Document
E3. Human Subjects Determination_2.pdf Supplementary Document
E2. Report of End of Human Research Review 0.1253.docx Supplementary Document
E1. Closure CDC Protocol # 4062.docx Supplementary Document
D2. Explanation for Program Changes or Adjustments 2024-0920-0666.docx Supplementary Document
D1. Explanation for Program Changes or Adjustments 2024-0920-0666_v2.docx Supplementary Document
B. 60-Day Published Federal Register Notice.pdf Supplementary Document
A3. 42 USC 242m.pdf Supplementary Document
A2. 42 USC 242k.pdf Supplementary Document
A1. 42 USC 242b.pdf Supplementary Document
SSB 0920-0666 September 2024.docx Supporting Statement B
SSA 0920-0666 September 2024_FINAL_final.docx Supporting Statement A
57.106 Patient Safety Monthly Reporting Plan Form and Instruction
All Hazards Form and Instruction
Bed Capacity-IT Initial Set Up Form and Instruction
External Validation Summary Report Form and Instruction
Seasonal Survey on Influenza Vaccination Programs for Healthcare Personnel Form and Instruction
Annual Healthcare Personnel Influenza Vaccination Summary (CSV) Form
Weekly Healthcare Personnel Influenza Vaccination Cumulative Summary for Non-Long-Term Care Facilities (CSV) Form
Patient Safety Attestation Form and Instruction
Pathogens of High Consequence Form and Instruction
AUR Pharmacy Data Electronic Upload Specification Tables (Yearly Maintenance) Form
AUR Pharmacy Data Electronic Upload Specification Tables (Initial Set-up) Form
AUR Microbiolgy Data Electronic Upload Specification Tables (Yearly Maintenance) Form
AUR Microbiology Data Electronic Upload Specification Tables (Initial Set-up) Form
NHSN Help Desk Customer Satisfaction Survey Form and Instruction
Hemovigilance Module Monthly Incident Summary Form and Instruction
Billing Code Data: 837I Upload Form
57.701 - Glycemic Control Module-HYPO Annual Survey Form and Instruction
57.700 - Medication Safety Component FHIR Measure-Glycemic Control Module Hypoglycemia-Infection Preventionist Form and Instruction
57.700 - Medication Safety Component FHIR Measure-Glycemic Control Module Hypoglycemia-IT Yearly Maintenance Form and Instruction
57.700 - Medication Safety Component FHIR Measure-Glycemic Control Module Hypoglycemia-IT Initial Set up Form and Instruction
57.600 - Neonatal Component Late Onset Sepsis Meningitis (LOSMEN) Module CDA Data Collection-Infection Preventionist Form and Instruction
57.600 - Neonatal Component FHIR Measure-Late Onset Sepsis Meningitis (LOSMEN) Module-Infection Preventionist Form and Instruction
57.600 - Neonatal Component FHIR Measure-Late Onset Sepsis Meningitis (LOSMEN) Module-IT Yearly Maintenance Form and Instruction
57.600 - Neonatal Component FHIR Measure-Late Onset Sepsis Meningitis (LOSMEN) Module-IT Initial Set up Form and Instruction
57.145 - Long Term Care Antimicrobial Use (LTC-AU) Module CDA Form and Instruction
57.144 - Long Term Care Respiratory Tract Infections (RTI) Module Form and Instruction
57.133 - Patient Safety Component FHIR Measures-VTE Module- Infection Preventionist Form and Instruction
57.133 - Patient Safety Component FHIR Measures-VTE Module-IT Yearly Maintenance Form and Instruction
57.133 - Patient Safety Component FHIR Measures-VTE Module-IT Initial Set up Form and Instruction
57.132 - Patient Safety Component FHIR Measures-HOB, HT-CDI Modules-Infection Preventionist Form and Instruction
57.132 - Patient Safety Component FHIR Measures-HOB, HT-CDI Modules-IT Yearly Maintenance Other-OMB Header and Burden Statement
57.132 - Patient Safety Component FHIR Measures-HOB, HT-CDI Modules-IT Initial Set up Other-OMB Header and Burden Statement
57.132 - Patient Safety Digital Reporting Plan (RPS CSV) Form and Instruction
57.130 - Patient Safety Component FHIR Measure Respiratory Pathogens Surveillance (RPS)-Infection Preventionist Form and Instruction
57.130 - Patient Safety Component FHIR Measure Respiratory Pathogens Surveillance (RPS) - IT Yearly Maintenance Form and Instruction
57.130 Patient Safety Component FHIR Measure Respiratory Pathogens Surveillance (RPS) - IT Initial Set up Form and Instruction
Monthly Survey Patient Days & Nurse Staffing Form and Instruction
Annual Healthcare Personnel Influenza Vaccination Summary (manual) Form and Instruction
Weekly Resident Influenza Vaccination Cumulative Summary for Long-Term Care Facilities Form and Instruction
Weekly Healthcare Personnel Influenza Vaccination Cumulative Summary for Long-Term Care Facilities Form and Instruction
Weekly Healthcare Personnel Influenza Vaccination Cumulative Summary for Non-Long-Term Care Facilities Form and Instruction
Late Onset Sepsis/Meningitis Denominator Form: Data Table (Monthly) Form and Instruction
Long Term Care Facility Component - Respiratory Tract Infection Form and Instruction
57.104 NHSN Administrator Change Request Form Form and Instruction
57.122 HAI Progress Report State Health Department Survey Form
57.405 Outpatient Procedure Component - Surgical Site Infection (SSI) Event Form
57.404 Outpatient Procedure Component - SSI Denominators Form
57.507 Home Dialysis Center Practices Survey Form
57.320 Hemovigilance Adverse Reaction - Other Transfusion Reaction Form
57.319 Hemovigilance Adverse Reaction - Unknown Transfusion Reaction Form
57.318 Hemovigilance Adverse Reaction - Transfusion Associated Circulatory Overload Form
57.317 Hemovigilance Adverse Reaction - Transfusion Associated Acute Lung Injury Form
57.316 Hemovigilance Adverse Reaction - Transfusion Associated Graft vs. Host Disease Form
57.315 Hemovigilance Adverse Reaction - Transfusion Associated Dyspnea Form
57.314 Hemovigilance Adverse Reaction - Post Transfusion Purpura Form
57.313 Hemovigilance Adverse Reaction - Infection Form
57.312 Hemovigilance Adverse Reaction - Hypotensive Transfusion Reaction Form
57.311 Hemovigilance Adverse Reaction - Febrile Non-hemolytic Transfusion Reaction Form
57.310 Hemovigilance Adverse Reaction - Delayed Serologic Transfusion Reaction Form
57.309 Hemovigilance Adverse Reaction - Delayed Hemolytic Transfusion Reaction Form
57.308 Hemovigilance Adverse Reaction - Allergic Transfusion Reaction Form
57.307 Hemovigilance Adverse Reaction - Acute Hemolytic Transfusion Reaction Form
57.306 Hemovigilance Module Annual Facility Survey - Non-acute Care Facility Form
57.129_Adult Sepsis Form
57.115 Custom Event Form
57.113 Pediatric Ventilator-Associated Event (PedVAE) Form and Instruction
57.506 Dialysis Patient Influenza Vaccination Denominator Form
57.505 Dialysis Patient Influenza Vaccination Form
57.504 Prevention Process Measures Monthly Monitoring for Dialysis Form
57.501 Dialysis Monthly Reporting Plan Form
57.403 Outpatient Procedure Component - Monthly Denominators and Summary Form
57.402 Outpatient Procedure Component Event Form
57.401 Outpatient Procedure - Monthly Reporting Plan Form
57.400 Outpatient Procedure - Annual Facility Survey Form
57.151 Patient Safety Component -- Annual Facility Survey for IRF Form and Instruction
57.150 Patient Safety Component -- Annual Facility Survey for LTAC Form and Instruction
57.143 Prevention Process Measures Monthly Monitoring for LTCF Form
57.142 Denominators for LTCF Locations Form
57.141 Monthly Reporting Plan for LTCF Form
57.112 Ventilator-Associated Event (VAE) Form and Instruction
57.139 MDRO and CDI Prevention Process Measures Monthly for LTCF Form
57.138 Laboratory-Identified MDRO or CDI Event for LTCF Form
57.137 Long Term care Facility Component--Annual Facility Survey Form
57.305 Hemovigilance Incident Form
57.303 Hemovigilance Module Monthly Reporting Denominators Form and Instruction
57.301 Hemovigilance Module Monthly Reporting Plan Form and Instruction
57.300 Hemovigilance Module Annual Survey -- Acute Care Facility Form
57.200 Healthcare Personnel Safety Component Facility Survey Form
57.204 Healthcare Worker Demographic Data Form
57.206 Healthcare Worker Prophylaxis/Treatment Form
57.205 Exposure to Blood and Body Fluids Form
57.105 Group Contact Information Form
57.140 Urinary Tract Infection (UTI) for LTCF Form and Instruction
57.103 Patient Safety Component - Annual Hospital Survey Form and Instruction
57.101 Facility Contact Information Form
57.124 Antimicrobial Use and Resistence (AUR) - Pharmacy Data Form and Instruction
57.123 Antimicrobial Use and Resistance (AUR) - Microbiology Data Upload Tables Form and Instruction
57.100 NHSN Registration Form Form
57.121 Denominators for Procedure Form and Instruction
57.128 Laboratory Identified or CDI MDRO Event Form
57.120 Surgical Site Infection (SSI) Form
57.126 MDRO or CDI Infection Event Form
57.503 Denominators for Outpatient Dialysis Form
57.127 MDRO and CDI Prevention Process and Outcome Measures Monthly Monitoring Form
57.118 Denominators for Intensive Care Unit (ICU) Other Locations (Not NICU or SCA) Form
57.207 Follow-up Laboratory Testing Form
57.117 Denominators for Specialty Care Area (SCA)/Onocology (ONC) Form
57.125 Central Line Insertion Practices Adherence Monitoring Form Form
57.116 Denominators for Neonatal Intensive Care Unit (NICU) Form
57.114 Urinary Tract Infection (UTI) Form and Instruction
57.210 Healthcare Worker Prophylaxis/Treatment - Influenza Form
57.111 Pneumonia (includes Any Patient Pneumonia flow Diagram and Infant and Children Pneumonia Flow Diagram) Form and Instruction
57.502 Dialysis Event Form and Instruction
57.108 Primary Bloodstream Infection (BSI) Form and Instruction
57.500 Outpatient Dialysis Center Practices Survey Form and Instruction
57.203 Healthcare Personnel Safety Reporting Plan Form

All Historical Document Collections

202410-0920-013	Revision of a currently approved collection	2024-11-15
202408-0920-016	No material or nonsubstantive change to a currently approved collection	2024-08-26
202402-0920-011 Approved without change	No material or nonsubstantive change to a currently approved collection	2024-02-28
202310-0920-013 Approved without change	Revision of a currently approved collection	2023-11-17
202301-0920-005 Approved with change	Revision of a currently approved collection	2023-04-26
202212-0920-013 Approved without change	Revision of a currently approved collection	2022-12-21
202112-0920-014 Approved with change	Revision of a currently approved collection	2022-01-03
202104-0920-002 Approved with change	No material or nonsubstantive change to a currently approved collection	2021-04-09
202102-0920-011 Approved without change	No material or nonsubstantive change to a currently approved collection	2021-02-23
202010-0920-016 Approved with change	Revision of a currently approved collection	2020-11-25
202006-0920-003 Approved with change	No material or nonsubstantive change to a currently approved collection	2020-06-04
201908-0920-004 Approved with change	Revision of a currently approved collection	2019-10-11
201808-0920-011 Approved with change	Revision of a currently approved collection	2018-10-11
201807-0920-002 Approved without change	No material or nonsubstantive change to a currently approved collection	2018-07-09
201801-0920-008 Approved without change	No material or nonsubstantive change to a currently approved collection	2018-01-31
201708-0920-029 Approved with change	Revision of a currently approved collection	2017-10-30
201607-0920-013 Approved with change	Revision of a currently approved collection	2016-08-17
201603-0920-007 Approved without change	No material or nonsubstantive change to a currently approved collection	2016-03-16
201508-0920-001 Approved with change	Revision of a currently approved collection	2015-09-11
201407-0920-007 Approved without change	Revision of a currently approved collection	2014-09-23
201308-0920-010 Approved without change	Revision of a currently approved collection	2013-08-28
201211-0920-005 Approved without change	Revision of a currently approved collection	2012-11-01
201112-0920-004 Approved without change	Revision of a currently approved collection	2011-12-08
201105-0920-001 Approved without change	Revision of a currently approved collection	2011-05-02
201104-0920-012 Improperly submitted and continue	Revision of a currently approved collection	2011-04-14
200908-0920-002 Approved without change	Revision of a currently approved collection	2009-08-19
200906-0920-001 Improperly submitted and continue	No material or nonsubstantive change to a currently approved collection	2009-06-08
200901-0920-009 Approved without change	No material or nonsubstantive change to a currently approved collection	2009-01-30
200801-0920-009 Approved without change	Revision of a currently approved collection	2008-01-30
200712-0920-003 Approved without change	No material or nonsubstantive change to a currently approved collection	2007-12-14
200701-0920-002 Withdrawn and continue	No material or nonsubstantive change to a currently approved collection	2007-01-12
200409-0920-012 Approved with change	New collection (Request for a new OMB Control Number)	2004-09-30

OMB Details

57.106 Patient Safety Monthly Reporting Plan

Federal Enterprise Architecture: Health - Health Care Services

Form CDC 57.106

Patient Safety Monthly Reporting Plan

Fillable Printable

Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.