Information Collection

57.202 Healthcare Worker Survey

IC 183542 under ICR 201112-0920-004 · OMB 0920-0666.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0666 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 57.202 57.202 Healthcare Worker Survey	Form
57.202 HealthCare Worker Survey 57.202_HCWPersonnelSurvey_BLANK.ppt	Form
6_HPS_toi.pdf 6_HPS_toi	IC Document
2_HPS_intro.pdf 2_HPS_intro	IC Document
7_HPS_keyTerms.pdf 7_HPS_keyTerms	IC Document
8_HPS_cdcCodes.pdf 8_HPS_cdcCodes	IC Document

IC Title:

57.202 Healthcare Worker Survey

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	57.202	HealthCare Worker Survey	57.202_HCWPersonnelSurvey_BLANK.ppt		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 600

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	60,000	60,000
Annual IC Time Burden (Hours)	10,000	10,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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