Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
COVID-19 Healthcare Worker Form - Business/Financial Operations Unchanged 93420 38925 0 Form and Instruction 0920-1290
COVID-19 Healthcare Worker Form - Microbiologist Unchanged 374220 155925 0 Form and Instruction 0920-1290
COVID-19 Healthcare Worker Form - State and Local Health Department Unchanged 93420 38925 0 Form and Instruction 0920-1290
COVID-19 Patient Impact Module Form - Business/Financial Operations Unchanged 93420 38925 0 Form NA
Instruction
COVID-19 Patient Impact Module Form - Microbiologist Unchanged 374220 155925 0 Form NA
Instruction
COVID-19 Patient Impact Module Form - State and Local Health Departments Unchanged 93420 38925 0 Form NA
Instruction
COVID-19 Supplies Form - Business/Financial Operations Unchanged 93420 38925 0 Form and Instruction 0920-1290
COVID-19 Supplies Form - Microbiologist Unchanged 374220 155925 0 Form and Instruction 0920-1290
COVID-19 Supplies Form - State and Local Health Department Unchanged 93420 38925 0 Form and Instruction 0920-1290
LTC Resident Impact - business operations occupations New 63596 21199 0 Form none
LTC Resident Impact - microbiologist New 254332 84777 0 Form none
LTC Resident Impact - state/local health depts. New 63596 21199 0 Form none
LTC Staff and Personnel Impact - business operations occupations New 63596 15899 0 Form none
LTC Staff and Personnel Impact - microbiologist New 254332 63583 0 Form none
LTC Staff and Personnel Impact - state/local health depts. New 63596 15899 0 Form none
LTC Supplies and PPE - business operations occupations New 63596 15899 0 Form none
LTC Supplies and PPE - microbiologists New 254332 63583 0 Form none
LTC Supplies and PPE - state/local health depts. New 63596 15899 0 Form none
LTC Ventilator Capacity - business operations occupations New 63596 5300 0 Form none
LTC Ventilator Capacity - microbiologists New 254332 21194 0 Form none
LTC Ventilator Capacity - state/local health depts. New 63596 5300 0 Form none
Total burden requested under this ICR: 3209276 1051056 0  
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