57.600 State Health Department Validation Record

The National Healthcare Safety Network (NHSN)

⚠️ Notice: This information collection may be referencing outdated material.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
Form CDC 57.600 57.600 State Health Department Validation Record Form
CDC 57.600 State Health Department Validation Record 57.600_State HD Validation Record_BLANK.DOCX Form
Att G.16_State Validation Record.pdf Att G.16_Table X. Instructions for Completion of State Health Department Validation Record form IC Document

Information Collection (IC) Details

IC Title:	57.600 State Health Department Validation Record	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

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 57.600	State Health Department Validation Record	57.600_State HD Validation Record_BLANK.DOCX		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 152	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-7,600	7,600
Annual IC Time Burden (Hours)	-1,900	1,900
Annual IC Cost Burden (Dollars)	-59,622	59,622

Documents for IC

Title	Document	Date Uploaded
Att G.16_Table X. Instructions for Completion of State Health Department Validation Record form	Att G.16_State Validation Record.pdf	08/28/2014

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