57.109 Becton Dickinson BACTECTM Blood Culture Media Bottles Shortage Impact Questionnaire

[NCEZID] The National Healthcare Safety Network (NHSN)

Documents and Forms

Document Name Document Type
Form 57.109 57.109 Becton Dickinson BACTECTM Blood Culture Media Bottles Shortage Impact Questionnaire Form and Instruction
57.109 Becton Dickinson BACTECTM Blood Culture Media Bottles Sh 57.109 Blood Culture Bottle Shortage Questionnaire.docx Form and Instruction
57.109 Becton Dickinson BACTECTM Blood Culture Media Bottles Sh 57.109 Blood Culture Bottle Shortage Questionnaire.docx Form and Instruction

Information Collection (IC) Details

IC Title:	57.109 Becton Dickinson BACTECTM Blood Culture Media Bottles Shortage Impact Questionnaire	Agency IC Tracking Number:	0920-0666-24IN

Is this a Common Form? No		IC Status: New

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	57.109	Becton Dickinson BACTECTM Blood Culture Media Bottles Shortage Impact Questionnaire	57.109 Blood Culture Bottle Shortage Questionnaire.docx	N/A	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,500	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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,500	3,500
Annual IC Time Burden (Hours)	1,167	1,167
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.