Information Collection

57.206 Healthcare Worker Prophylaxis/Treatment

IC 183578 under ICR 201808-0920-011 · 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⚠️ Notice: This information collection may be referencing outdated material.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 CDC 57.206 57.206 Healthcare Worker Prophylaxis/Treatment	Form
CDC 57.206 Healthcare Worker Prophylaxis/Treatment 57.206_HCWPEP_BLANK.docx	Form
G12. Healthcare Personnel Exposure.pdf Att G12_Healthcare Personnel Exposure	IC Document

IC Title:

57.206 Healthcare Worker Prophylaxis/Treatment

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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	CDC 57.206	Healthcare Worker Prophylaxis/Treatment	57.206_HCWPEP_BLANK.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, 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	1,500	1,500
Annual IC Time Burden (Hours)	375	375
Annual IC Cost Burden (Dollars)	12,655	12,655

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att G12_Healthcare Personnel Exposure	G12. Healthcare Personnel Exposure.pdf	08/08/2016

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