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
57.140 NHSN and Secure Access Management Services (SAMS) enrollment Modified 11500 958 0 Form and Instruction 0920-1317 NHSN Registration Form
57.155 Point of Care Testing Results - CSV New 470250 94050 0 Form and Instruction 57.155 Point of Care Testing Results
57.155 Point of Care Testing Results - Manual Modified 470250 94050 0 Form and Instruction 57.155 Point of Care Testing Results
57.220 Weekly Person Level Respiratory Pathogen and Vaccination for Residents-LTCF Component_CSV New 83200 55467 0 Form and Instruction 57.220 Weekly Person Level Respiratory Pathogen and Vaccination for Residents-LTCF Component_CSV
57.220 Weekly Person Level Respiratory Pathogen and Vaccination for Residents-LTCF Component_Manual New 83200 83200 0 Form and Instruction 57.220 Weekly Person Level Respiratory Pathogen and Vaccination for Residents-LTCF Component_Manual
57.221 Healthcare Personnel COVID-19 Person Level Vaccination-Healthcare Personnel Safety Component_CSV New 876 584 0 Form and Instruction 57.221 57.221 Healthcare Personnel COVID-19 Person Level Vaccination-Healthcare Personnel Safety Component_CSV
57.221 Healthcare Personnel COVID-19 Person Level Vaccination-Healthcare Personnel Safety Component_Manual New 876 876 0 Form and Instruction 57.221 57.221 Healthcare Personnel COVID-19 Person Level Vaccination-Healthcare Personnel Safety Component_Manual
57.221 Healthcare Personnel COVID-19 Person Level Vaccination-LTC Component _Manual New 3796 3796 0 Form and Instruction 57.221 Healthcare Personnel COVID-19 Person Level Vaccination-LTC Component_Manual
57.221 Healthcare Personnel COVID-19 Person Level Vaccination-LTC Component_CSV New 3796 2531 0 Form and Instruction 57.221 Healthcare Personnel COVID-19 Person Level Vaccination-LTC Component_CSV
57.509 Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities-.CSV New 33624 22416 0 Form and Instruction 57.509 57.509 Weekly COVID-19 Vaccination Cumulative Summary for Dialysis Patients_CSV
57.509 Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities_Manual Modified 1284 963 0 Form and Instruction 57.509 Weekly COVID-19 Vaccination Cumulative Summary for Dialysis Patients_Manual
57.510 COVID–19 Module Dialysis Outpatient Facility-CSV New 6000 1000 0 Form and Instruction 57.510 57.510 COVID–19 Module Dialysis Outpatient Facility-.csv
57.510 COVID–19 Module Dialysis Outpatient Facility_Manual Modified 6000 2000 0 Form and Instruction 57.510 COVID–19 Module - Dialysis Outpatient Facility
Healthcare Personnel Safety Monthly Reporting Plan - completed by Dialysis Facilities Removed 0 0 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 Removed 0 0 0 Form and Instruction CDC Form 57.203 Healthcare Personnel Safety Monthly Reporting Plan
Long Term Care Facility Resident Impact and Facility Capacity Pathway Removed 0 0 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 Removed 0 0 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) Removed 0 0 0 Form and Instruction n/a NHSN COVID-19 Hospital Module Infusion Centers and Outpatient Clinics
Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel (.csv) Modified 5512 5696 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) Modified 4992 5158 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) Modified 8684 8973 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) Modified 86788 89681 0 Form and Instruction 57.216 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents
Staff and Personnel Impact - Business and Financial Operations Occupations Removed 0 0 0 Form and Instruction CDC 57.145 Staff and Personnel Impact
Staff and Personnel Impact - Business and Financial Operations Occupations retrospective Removed 0 0 0 Form and Instruction CDC 57.145 Staff and Personnel Impact
Staff and Personnel Impact - LTCF Personnel Removed 0 0 0 Form and Instruction CDC 57.145 Staff and Personnel Impact
Staff and Personnel Impact - LTCF Personnel retrospective Removed 0 0 0 Form and Instruction CDC 57.145 Staff and Personnel Impact
Staff and Personnel Impact - State and Local Health Dept Occupations Removed 0 0 0 Form and Instruction CDC 57.145 Staff and Personnel Impact
Staff and Personnel Impact - State and Local Health Dept Occupations retrospective Removed 0 0 0 Form and Instruction CDC 57.145 Staff and Personnel Impact
VA - Resident COVID-19 Event Form - LTCF Removed 0 0 0 Form and Instruction 0920-1317 VA COVID-19 Resident Event Form
VA - Staff and Personnel COVID-19 Event Form - LTCF Removed 0 0 0 Form and Instruction 0920-1317 VA - Staff and Personnel COVID-19 Event Form
Weekly Healthcare Personnel COVID-19 Vaccination Cumulative Summary (.csv) Unchanged 49284 32856 0 Form and Instruction 57.219 Healthcare Personnel COVID-19 Vaccination Cumulative Summary
Weekly Healthcare Personnel COVID-19 Vaccination Cumulative Summary (manual) Unchanged 136320 102240 0 Form and Instruction 57.219 Healthcare Personnel COVID-19 Vaccination Cumulative Summary
Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities (.csv) Unchanged 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 Form 57.218 Weekly Respiratory Pathogen and Vaccination Summary for Residents of Long-Term Care Facilities (manual)
Total burden requested under this ICR: 3653433 1752540 0  
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