COVID-19 Patient Impact Module Form - Microbiologist

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 - Microbiologist
 
No Modified
 
Voluntary
 

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

Health Public Health Monitoring

 

2,079 0
   
Individuals or Households
 
   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 374,220 0 -327,780 0 0 702,000
Annual IC Time Burden (Hours) 155,925 0 -78,075 0 0 234,000
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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