57.503 Denominators for Outpatient Dialysis

[NCEZID] The National Healthcare Safety Network (NHSN)

Documents and Forms

Document Name Document Type
Form CDC 57.503 57.503 Denominators for Outpatient Dialysis Form
CDC 57.503 Demominators for Dialysis Event Surveillance 57.503 Denominator for Outpatient Dialysis-Clean Version.docx Form

Information Collection (IC) Details

IC Title:	57.503 Denominators for Outpatient Dialysis	Agency IC Tracking Number:	0920-0666

Is this a Common Form? No		IC Status: Modified

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 57.503	Demominators for Dialysis Event Surveillance	57.503 Denominator for Outpatient Dialysis-Clean Version.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 7,400	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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	88,800	-88,800	177,600
Annual IC Time Burden (Hours)	14,800	-14,800	29,600
Annual IC Cost Burden (Dollars)	0	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.