Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Dialysis Component Unchanged 800800 333667 0 Form and Instruction n/a COVID–19 Module - Dialysis Outpatient Facility
Healthcare Personnel Safety Monthly Reporting Plan - completed by Dialysis Facilities Unchanged 69300 5775 0 Form and Instruction CDC Form 57.203 Healthcare Personnel Safety Monthly Reporting Plan
Healthcare Personnel Safety Monthly Reporting Plan - completed by Inpatient Psychiatric Facilities Unchanged 4728 394 0 Form and Instruction CDC Form 57.203 Healthcare Personnel Safety Monthly Reporting Plan
Monthly Reporting Plan form for Long-term Care Facilities Unchanged 151776 12648 0 Form and Instruction CDC Form 57.141 Monthly Reporting Plan for LTCF
NHSN COVID-19 Hospital Module (Hospitals) Unchanged 2190000 3285000 0 Form and Instruction n/a NHSN COVID-19 Hospital Module
NHSN COVID-19 Hospital Module (Infusion Centers and Outpatient Clinics reporting Inventory & use of therapeutics (MABs) Unchanged 20800 5200 0 Form and Instruction n/a NHSN COVID-19 Hospital Module Infusion Centers and Outpatient Clinics
NHSN and Secure Access Management Services (SAMS) enrollment Unchanged 11500 11500 0 Form and Instruction 0920-1317 NHSN Registration Form
Resident Impact and Facility Capacity - Business and Financial Operations Occupations retrospective Modified 935 234 0 Form and Instruction CDC 57.144 Resident Impact and Facility Capacity
Resident Impact and Facility Capacity - LTCF Personnel retrospective Modified 5811 1453 0 Form and Instruction CDC 57.144 Resident Impact and Facility Capacity
Resident Impact and Facility Capacity - LTCF Personnel, Business and Financial operations and State and Local Health Dept. Occupations Modified 858624 214656 0 Form and Instruction CDC 57.144 Resident Impact and Facility Capacity
Resident Impact and Facility Capacity - State and Local Health Dept Occupations retrospective Modified 935 234 0 Form and Instruction CDC 57.144 Resident Impact and Facility Capacity
Resident Therapeutics - Business and Financial Operations Occupations Removed 0 0 0 Form and Instruction 0920-1317 CDC 57.XXX Long Term Care Facility: Resident Therapeutics
Resident Therapeutics - LTCF Personnel Removed 0 0 0 Form and Instruction 0920-1317 CDC 57.XXX Long-Term Care Facility: Resident Therapeutics
Resident Therapeutics - State and Local Health Dept. Occupations Removed 0 0 0 Form and Instruction 0920-1317 CDC 57.XXX Long Term Care Facility: Resident Therapeutics
Staff and Personnel Impact - Business and Financial Operations Occupations Modified 97240 8103 0 Form and Instruction CDC 57.145 Staff and Personnel Impact
Staff and Personnel Impact - Business and Financial Operations Occupations retrospective Modified 935 78 0 Form and Instruction CDC 57.145 Staff and Personnel Impact
Staff and Personnel Impact - LTCF Personnel Modified 604292 50358 0 Form and Instruction CDC 57.145 Staff and Personnel Impact
Staff and Personnel Impact - LTCF Personnel retrospective Modified 5811 484 0 Form and Instruction CDC 57.145 Staff and Personnel Impact
Staff and Personnel Impact - State and Local Health Dept Occupations Modified 97240 8103 0 Form and Instruction CDC 57.145 Staff and Personnel Impact
Staff and Personnel Impact - State and Local Health Dept Occupations retrospective Modified 935 78 0 Form and Instruction CDC 57.145 Staff and Personnel Impact
VA - Resident COVID-19 Event Form - LTCF Unchanged 6768 3948 0 Form and Instruction 0920-1317 VA COVID-19 Resident Event Form
VA - Staff and Personnel COVID-19 Event Form - LTCF Unchanged 6768 2256 0 Form and Instruction 0920-1317 VA - Staff and Personnel COVID-19 Event Form
Weekly Healthcare Personnel COVID-19 Vaccination Cumulative Summary Unchanged 655200 982800 0 Form and Instruction CDC Form 57.219 Healthcare Personnel COVID-19 Vaccination Cumulative Summary
Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities Unchanged 400400 500500 0 Form and Instruction 0920-1317 / CDC Form 57.509 Weekly COVID-19 Vaccination Cumulative Summary for Dialysis Patients
Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities Unchanged 876928 1096160 0 Form and Instruction 0920-1317 / CDC Form 57.218 Weekly COVID-19 Vaccination Cumulative Summary for Residents of Long-Term Care Facilities
Total burden requested under this ICR: 6867726 6523629 0  
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