Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
57.101 Hospital Respiratory Data Form (Weekly - .csv import) New 179088 86559 0 Form and Instruction 0920-1317
57.101 Hospital Respiratory Data Form (Weekly - API) New 92872 23218 0 Form and Instruction 0920-1317
57.101 Hospital Respiratory Data Form (Weekly - User Entry) New 59696 200977 0 Form and Instruction 0920-1317
57.102 - Hospital Respiratory Data Fomr (Daily - API) New 279225 69806 0 Form and Instruction 57.102
57.102 - Hospital Respiratory Data Form (Daily - user entry) New 179580 173594 0 Form and Instruction 57.102
57.102 Hospital Respiratory Data Form (Daily - .csv import) New 538740 260391 0 Form and Instruction 57.102
COVID-19 Hospital Data Form (Psychiatric and Rehabilitation Facilities) Removed 0 0 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) Removed 0 0 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 Unchanged 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 Unchanged 858000 357500 0 Form and Instruction 0920-1317 / CDC Form 57.218
Form and Instruction 0920-1317
Total burden requested under this ICR: 8295144 4426312 0  
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