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Agenda
Reg Review
ICR
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
Unchanged
11500
958
0
Form and Instruction
0920-1317
NHSN Registration Form
57.155 Point of Care Testing Results - CSV
Unchanged
470250
94050
0
Form and Instruction
57.155
Point of Care Testing Results
57.155 Point of Care Testing Results - Manual
Unchanged
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
Unchanged
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
Unchanged
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
Unchanged
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
Unchanged
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
Unchanged
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
Unchanged
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
Unchanged
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
Unchanged
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
Unchanged
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
Unchanged
6000
2000
0
Form and Instruction
57.510
COVID–19 Module - Dialysis Outpatient Facility
Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel (.csv)
Unchanged
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)
Unchanged
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)
Unchanged
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)
Unchanged
86788
89681
0
Form and Instruction
57.216
Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents
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)
Modified
79352
26451
0
Form and Instruction
57.218
Weekly Respiratory Pathogen and Vaccination Summary for Residents of Long-Term Care Facilities
Form and Instruction
57.218
Weekly Respiratory Pathogen and Vaccination Summary for Residents of LTCF (.csv)
Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities (manual)
Modified
682396
284332
0
Form and Instruction
Form 57.218
Weekly Respiratory Pathogen and Vaccination Summary for Residents of Long-Term Care Facilities (manual)
Form and Instruction
57.218
Weekly Respiratory Pathogen and Vaccination Summary for Residents of LTCF (manual)
Total burden requested under this ICR:
3557181
1731823
0
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