57.114 Urinary Tract Infection (UTI)

[NCEZID] The National Healthcare Safety Network (NHSN)

Documents and Forms

Document Name Document Type
Form 57.114 57.114 Urinary Tract Infection (UTI) Form and Instruction
57.114 Urinary Tract infection (UTI) 57.114_UTI_BLANK_November_2022.docx Form and Instruction
57.114 Urinary Tract infection (UTI) 57.114_UTI_BLANK_November_2022.docx Form and Instruction
57.114_UTI_BLANK_November_2022.docx 57.114 UTI form with GISAB edits in tracked changes IC Document
57.114_UTI_BLANK_November_2022.docx 57.114 UTI form with GISAB edits in tracked changes IC Document

Information Collection (IC) Details

IC Title:	57.114 Urinary Tract Infection (UTI)	Agency IC Tracking Number:	0920-0666

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 and Instruction	57.114	Urinary Tract infection (UTI)	57.114_UTI_BLANK_November_2022.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: 6,000	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 %

	Requested	Previously Approved
Annual Number of Responses for this IC	30,000	30,000
Annual IC Time Burden (Hours)	10,500	10,500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
57.114 UTI form with GISAB edits in tracked changes	57.114_UTI_BLANK_November_2022.docx	04/25/2023

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