View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	NHSN COVID-19 Hospital Module - Hospitals (excluding Psychiatric and Rehabilitation Facilities)	Agency IC Tracking Number:	0920-1317

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	n/a	NHSN COVID-19 Hospital Module	Hospital COVID Data Form - webform_FINAL.docx		Yes	Yes	Fillable Fileable
Form and Instruction	0920-1317	COVID-19 Hospital Data Form	Form-COVID-19 Hospital Data Form-Clean Version.docx	N/A	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5,200	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	0	0	-1,898,000	0	0	1,898,000
Annual IC Time Burden (Hours)	0	0	-2,847,000	0	0	2,847,000
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
TOI COVID-19 Hospital Module Form	TOI-for Completion of the COVID-19 Hospital Data Reporting Form.docx	09/07/2023

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.