Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
COVID-19 Hospital Data Form (Psychiatric and Rehabilitation Facilities) Unchanged 870 1305 0 Form and Instruction 0920-1317
Dialysis Component Unchanged 800800 333667 0 Form and Instruction n/a
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 - completed by Inpatient Psychiatric Facilities Unchanged 4728 394 0 Form and Instruction CDC Form 57.203
Long Term Care Facility Resident Impact and Facility Capacity Pathway Unchanged 858000 357500 0 Form and Instruction CDC 57.144
Form and Instruction 57.144
Monthly Reporting Plan form for Long-term Care Facilities Unchanged 151776 12648 0 Form and Instruction CDC Form 57.141
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 - Hospitals (excluding Psychiatric and Rehabilitation Facilities) Unchanged 1898000 2847000 0 Form and Instruction n/a
Form and Instruction 0920-1317
NHSN and Secure Access Management Services (SAMS) enrollment Unchanged 11500 11500 0 Form and Instruction 0920-1317
Point of Care Testing Results Unchanged 470250 78375 0 Form and Instruction 57.155
Staff and Personnel Impact - Business and Financial Operations Occupations Unchanged 97240 8103 0 Form and Instruction CDC 57.145
Staff and Personnel Impact - Business and Financial Operations Occupations retrospective Unchanged 935 78 0 Form and Instruction CDC 57.145
Staff and Personnel Impact - LTCF Personnel Unchanged 604292 50358 0 Form and Instruction CDC 57.145
Staff and Personnel Impact - LTCF Personnel retrospective Unchanged 5811 484 0 Form and Instruction CDC 57.145
Staff and Personnel Impact - State and Local Health Dept Occupations Unchanged 97240 8103 0 Form and Instruction CDC 57.145
Staff and Personnel Impact - State and Local Health Dept Occupations retrospective Unchanged 935 78 0 Form and Instruction CDC 57.145
VA - Resident COVID-19 Event Form - LTCF Unchanged 6768 3948 0 Form and Instruction 0920-1317
VA - Staff and Personnel COVID-19 Event Form - LTCF Unchanged 6768 2256 0 Form and Instruction 0920-1317
Weekly Healthcare Personnel COVID-19 Vaccination Cumulative Summary Modified 2500400 1875300 0 Form and Instruction CDC Form 57.219
Form and Instruction 0920-1317
Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities Unchanged 400400 500500 0 Form and Instruction 0920-1317 / CDC Form 57.509
Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities Modified 858000 357500 0 Form and Instruction 0920-1317 / CDC Form 57.218
Form and Instruction 57.218
Form and Instruction 0920-1317
Total burden requested under this ICR: 8864813 6460072 0  
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