COVID-19 Patient Impact Module Form

National Healthcare Safety Network (NHSN) Patient Impact Module for Coronavirus (COVID-19) Surveillance in Healthcare Facilities

OMB: 0920-1290

IC ID: 240833

Information Collection (IC) Details

View Information Collection (IC)

COVID-19 Patient Impact Module Form 0920-20LW
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 0920-20LW COVID-19 Patient Impact Module Form Att4a_COVID-19 Patient Impact Module Form_clean.docx Yes Yes Fillable Fileable
Instruction Att4b_Instructions for COVID-19 Patient Impact Module Form_clean.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

 

3,900 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   100 %

  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 702,000 0 702,000 0 0 0
Annual IC Time Burden (Hours) 234,000 0 234,000 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

© 2024 OMB.report | Privacy Policy