Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Business and Financial Operations Occupations - Resident Impact/Facility Capacity Form - Retrospective Data Entry Unchanged 1223 306 0 Form and Instruction 0920-1290
Business and Financial Operations Occupations - Staff and Personnel Impact - Retrospective Data Entry Unchanged 1223 306 0 Form and Instruction 0920-1290
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 62280 0 Form NA
Instruction
Form 0920-1290
Instruction
Form 09201290
Instruction
COVID-19 Patient Impact Module Form - Microbiologist Unchanged 374220 249480 0 Form NA
Instruction
Form 0920-1290
Instruction
Form 00920-1290
Instruction
COVID-19 Patient Impact Module Form - State and Local Health Departments Unchanged 93420 62280 0 Form NA
Instruction
Form 0920-1290
Instruction
Form 0920-1290
Instruction
COVID-19 Supplies Form - Business/Financial Operations Unchanged 93420 46710 0 Form and Instruction 0920-1290
Form and Instruction 0920-1290
COVID-19 Supplies Form - Microbiologist Unchanged 374220 187110 0 Form and Instruction 0920-1290
Form and Instruction 0920-1290
COVID-19 Supplies Form - State and Local Health Department Unchanged 93420 46710 0 Form and Instruction 0920-1290
Form and Instruction 0920-1290
LTC Staff and Personnel Impact - business operations occupations Unchanged 63596 15899 0 Form none
LTC Staff and Personnel Impact - microbiologist Unchanged 254332 63583 0 Form none
LTC Staff and Personnel Impact - state/local health depts. Unchanged 63596 15899 0 Form none
LTC Supplies and PPE - business operations occupations Unchanged 63596 15899 0 Form none
LTC Supplies and PPE - microbiologists Unchanged 254332 63583 0 Form none
LTC Supplies and PPE - state/local health depts. Unchanged 63596 15899 0 Form none
LTC Ventilator Capacity - business operations occupations Unchanged 63596 5300 0 Form none
LTC Ventilator Capacity - microbiologists Unchanged 254332 21194 0 Form none
LTC Ventilator Capacity - state/local health depts. Unchanged 63596 5300 0 Form none
LTCF Personnel - Resident Impact/Facility Capacity - Retrospective Data Entry Unchanged 4891 1223 0 Form and Instruction 0920-1290
LTCF Personnel - Staff and Personnel Impact - Retrospective Data Entry Unchanged 4891 1223 0 Form and Instruction 0920-1290
LTCF Resident Impact and Facility Capacity - LTCF personnel Modified 254332 169555 0 Form none
Form and Instruction 0920-1290
LTCF Resident Impact and Facitlity Capacity - Business and Financial Operations Occupations Modified 63596 42397 0 Form none
Form and Instruction 0920-1290
LTCF Resident Impact and Facitlity Capacity - State/Local Health Department Occupations. Modified 63596 42397 0 Form none
Form and Instruction 0920-1290
NHSN and Secure Access Management Services (SAMS) Enrollment Unchanged 11500 11500 0 Form and Instruction 0920-1290
State and Local Health Department - Resident Impact / Facility Capacity Form (Retrospective Datat Entry) Unchanged 1223 306 0 Form and Instruction 0920-1290
State and Local Health Departments - Staff and Personnel Impact - Retrospective Data Entry Unchanged 1223 306 0 Form and Instruction 0920-1290
TeleTracking (TT) - U.S. HealthCare COVID-19 Portal Unchanged 90000 45000 0 Form and Instruction 0920-1290
Total burden requested under this ICR: 3325450 1425420 0  
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