57.506 Dialysis Patient Influenza Vaccination Denominator

[NCEZID] 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⚠️ Notice: This information collection may be referencing outdated material.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 57.506 57.506 Dialysis Patient Influenza Vaccination Denominator Form
CDC 57.506 Dialysis Patient Influenza Vaccination Denominator 57.506_DIAL Patient Flu Vacc Denom_BLANK.docx Form
CDC 57.506 Dialysis Patient Influenza Vaccination Denominator 57.506_DIAL Patient Flu Vacc Denom_BLANK.docx Form
G10. Dialysis Patient Influenza Vaccination.pdf Att G10_Dialysis Patient Influenze Vaccination IC Document
G10. Dialysis Patient Influenza Vaccination.pdf Att G10_Dialysis Patient Influenze Vaccination IC Document

Information Collection (IC) Details

IC Title:	57.506 Dialysis Patient Influenza Vaccination Denominator	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 57.506	Dialysis Patient Influenza Vaccination Denominator	57.506_DIAL Patient Flu Vacc Denom_BLANK.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 615	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	Previously Approved
Annual Number of Responses for this IC	3,075	3,075
Annual IC Time Burden (Hours)	513	513
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att G10_Dialysis Patient Influenze Vaccination	G10. Dialysis Patient Influenza Vaccination.pdf	08/08/2016

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