57.202 Healthcare Worker Survey

The National Healthcare Safety Network (NHSN)

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

IC Title:	57.202 Healthcare Worker Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

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
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 %

	Change Due to Adjustment in Agency Estimate	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.