Information Collection

National Surveillance System for Health Care Workers

IC 6828 under ICR 200409-0920-002 · OMB 0920-0417.

Documents and Forms

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Information Collection (IC) Details

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IC Title:	National Surveillance System for Health Care Workers	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 75	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,349	-179,161	180,510
Annual IC Time Burden (Hours)	17,907	-19,490	37,397
Annual IC Cost Burden (Dollars)	15,000	5,000	10,000

Documents for IC

Title	Document	Date Uploaded

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