57.145 - Long Term Care Antimicrobial Use (LTC-AU) Module CDA

[NCEZID] The National Healthcare Safety Network (NHSN)

Documents and Forms

Document Name Document Type
Form 57.145 57.145 - Long Term Care Antimicrobial Use (LTC-AU) Module CDA Form and Instruction
57.145 LTC-AU Module 57.145 Long-Term Care Facilities Antimicrobial Use (LTC-AU) Module-Form.docx Form and Instruction
57.145 LTC-AU Module 57.145 Long-Term Care Facilities Antimicrobial Use (LTC-AU) Module-Form.docx Form and Instruction

Information Collection (IC) Details

IC Title:	57.145 - Long Term Care Antimicrobial Use (LTC-AU) Module CDA	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	57.145	LTC-AU Module	57.145 Long-Term Care Facilities Antimicrobial Use (LTC-AU) Module-Form.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 16,500	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	198,000	198,000
Annual IC Time Burden (Hours)	16,500	16,500
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.