Information Collection Request

Emerging Infections Program Tracking of SARS-CoV-2 Infections among Healthcare Personnel

ICR 202004-0920-012 · OMB 0920-1296 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 0920-20MZ EIP or State Health Dept Employee Form and Instruction New Available
Form 0920-20MZ Occupational Health Nurses at Healthcare Facilities (no form) Form New Available
Form 0920-20MZ Assessment of Healthcare Personnel Exposed to or Infected with SARS-CoV-2 Form and Instruction New Available
Emergency Review Request Memo - EIP Tracking of SARS-CoV-2 Infections among HCP_signed.pdf Supplementary Document Uploaded 2020-04-20 Available
Att5_Research Determination Form.pdf Supplementary Document Uploaded 2020-04-20 Available
Attachment3_Protocol omb_20200422.docx Supplementary Document Uploaded 2020-04-28 Available
Att1_Authorizing Legislation.docx Supplementary Document Uploaded 2020-04-20 Available
SSB_Tracking of HCP with COVID-19 omb_20200422.docx Supporting Statement B Uploaded 2020-04-28 Available
SSA_Tracking of HCP with COVID-19 omb_20200422.docx Supporting Statement A Uploaded 2020-04-28 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
241587 EIP or State Health Dept Employee Form and Instruction New
241437 Occupational Health Nurses at Healthcare Facilities (no form) Form New
241429 Assessment of Healthcare Personnel Exposed to or Infected with SARS-CoV-2 Form and Instruction New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
10/31/2020 6 Months From Approved
5,320 0 0
2,310 0 0
0 0 0





table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 5,320 0 0 5,320 0 0
Annual Time Burden (Hours) 2,310 0 0 2,310 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No