Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
57.101 Hospital Respiratory Data Form (Weekly - .csv import) Unchanged 179088 86559 0 Form and Instruction 0920-1317 Hospital Respiratory Data Weekly Reporting Form
57.101 Hospital Respiratory Data Form (Weekly - API) Unchanged 92872 23218 0 Form and Instruction 0920-1317 Hospital Respiratory Data Weekly Reporting Form
57.101 Hospital Respiratory Data Form (Weekly - User Entry) Unchanged 59696 200977 0 Form and Instruction 0920-1317 Hospital Respiratory Data Weekly Reporting Form
57.102 - Hospital Respiratory Data Fomr (Daily - API) Unchanged 279225 69806 0 Form and Instruction 57.102 Hospital Respiratory Data Daily Reporting Form 14AUG2024
57.102 - Hospital Respiratory Data Form (Daily - user entry) Unchanged 179580 173594 0 Form and Instruction 57.102 Hospital Respiratory Data Daily Reporting Form 14AUG2024
57.102 Hospital Respiratory Data Form (Daily - .csv import) Unchanged 538740 260391 0 Form and Instruction 57.102 Hospital Respiratory Data Daily Reporting Form 14AUG2024
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
Long Term Care Facility Resident Impact and Facility Capacity Pathway Unchanged 858000 357500 0 Form and Instruction CDC 57.144 Resident Impact and Facility Capacity
Form and Instruction 57.144 COVID-19 and Respiratory Infections Module Long Term Care Facility Resident Impact and Facility Capacity Pathway Form (57.144) 07SEP2023
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 (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
Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel (.csv) New 5512 5512 0 Form and Instruction 57.217 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel
Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel (manual) New 4992 4992 0 Form and Instruction 57.217 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel
Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents (.csv) New 8684 8684 0 Form and Instruction 57.216 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents
Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents (manual) New 86788 86788 0 Form and Instruction 57.216 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents
Point of Care Testing Results Unchanged 470250 78375 0 Form and Instruction 57.155 Point of Care Testing Results
Staff and Personnel Impact - Business and Financial Operations Occupations Unchanged 97240 8103 0 Form and Instruction CDC 57.145 Staff and Personnel Impact
Staff and Personnel Impact - Business and Financial Operations Occupations retrospective Unchanged 935 78 0 Form and Instruction CDC 57.145 Staff and Personnel Impact
Staff and Personnel Impact - LTCF Personnel Unchanged 604292 50358 0 Form and Instruction CDC 57.145 Staff and Personnel Impact
Staff and Personnel Impact - LTCF Personnel retrospective Unchanged 5811 484 0 Form and Instruction CDC 57.145 Staff and Personnel Impact
Staff and Personnel Impact - State and Local Health Dept Occupations Unchanged 97240 8103 0 Form and Instruction CDC 57.145 Staff and Personnel Impact
Staff and Personnel Impact - State and Local Health Dept Occupations retrospective Unchanged 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 (.csv) New 49284 32856 0 Form and Instruction 57.219 Healthcare Personnel COVID-19 Vaccination Cumulative Summary
Weekly Healthcare Personnel COVID-19 Vaccination Cumulative Summary (manual) Modified 136320 102240 0 Form and Instruction 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 (.csv) New 312000 104000 0 Form and Instruction 57.218 Weekly Respiratory Pathogen and Vaccination Summary for Residents of Long-Term Care Facilities
Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities (manual) Modified 546000 227500 0 Form and Instruction 57.218 Weekly Respiratory Pathogen and Vaccination Summary for Residents of Long-Term Care Facilities
Total burden requested under this ICR: 6086324 2766084 0  
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