Residents by Location Form

Survey of Healthcare-Associated Infections and Antimicrobial Use in U.S. Nursing Homes for use in Exploring the Development of a National Prevalence Model

OMB: 0920-1165

IC ID: 221654

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Information Collection (IC) Details

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Residents by Location Form
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction NA Residents by Location Form Att D - Residents by Location Form_05182016.docx NA Yes Yes Fillable Fileable

Health Public Health Monitoring

 

400 0
   
Individuals or Households
 
   50 %

  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 15,200 0 15,200 0 0 0
Annual IC Time Burden (Hours) 5,067 0 5,067 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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