57.151 Patient Safety Component -- Annual Facility Survey for IRF

[NCEZID] The National Healthcare Safety Network (NHSN)

Documents and Forms

Document Name Document Type
Form 57.151 57.151 Patient Safety Component -- Annual Facility Survey for IRF Form and Instruction
57.151 Patient Safety Component—Annual Facility Survey for IRF 57.151 REHAB Annual Facility Survey-Clean Version.docx Form and Instruction
57.151 Patient Safety Component—Annual Facility Survey for IRF 57.151 REHAB Annual Facility Survey-Clean Version.docx Form and Instruction

Information Collection (IC) Details

IC Title:	57.151 Patient Safety Component -- Annual Facility Survey for IRF	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	57.151	Patient Safety Component—Annual Facility Survey for IRF	57.151 REHAB Annual Facility Survey-Clean Version.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: 1,160	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	1,160	1,160
Annual IC Time Burden (Hours)	1,721	1,721
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.