Information Collection

57.120 Surgical Site Infection (SSI)

IC 183562 under ICR 201211-0920-005 · OMB 0920-0666.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0666 can be found here:

Documents and Forms

Document Name Document Type
57.120_SSI_BLANK.docx Other-WORD
15. Surgical Site Infection (IC# 21).pdf Att G.15 SSI IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	57.120 Surgical Site Infection (SSI)	Agency IC Tracking Number:

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
Other-WORD			57.120_SSI_BLANK.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

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: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	216,000	216,000
Annual IC Time Burden (Hours)	115,200	115,200
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att G.15 SSI	15. Surgical Site Infection (IC# 21).pdf	10/15/2012

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