57.116 Denominators for Neonatal Intensive Care Unit (NICU)

The National Healthcare Safety Network (NHSN)

⚠️ Notice: This information collection may be referencing outdated material.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 57.116 57.116 Denominators for Neonatal Intensive Care Unit (NICU) Form
CDC 57.116 PedVAE Optional Denominators Neonatal Intensive Care Uni 57.116_DenominatorNICU_BLANK.docx Form
8. Denominators for Patient Safety Component.pdf Att G7_Demoninators for Patient Safety Component IC Document

Information Collection (IC) Details

IC Title:	57.116 Denominators for Neonatal Intensive Care Unit (NICU)	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	CDC 57.116	PedVAE Optional Denominators Neonatal Intensive Care Unit (NICU)	57.116_DenominatorNICU_BLANK.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: 1,100	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 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	13,200	10,560	2,640
Annual IC Time Burden (Hours)	880	-10,736	11,616
Annual IC Cost Burden (Dollars)	1,713,360	1,370,688	342,672

Documents for IC

Title	Document	Date Uploaded
Att G7_Demoninators for Patient Safety Component	8. Denominators for Patient Safety Component.pdf	09/25/2018

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.