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LTC Staff and Personnel Impact

ICR 202005-0920-001 · OMB 0920-1290 · Object 100802501.

This document may belong to an older filing. More recent activity for OMB 0920-1290:

2020-08-26 · No material or nonsubstantive change to a currently approved collection
2020-07-30 · No material or nonsubstantive change to a currently approved collection

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Document Metadata

Record metadata
File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
File Title	LTC Staff and Personnel Impact
Author	Wattenmaker, Lauren (CDC/DDID/NCEZID/DHQP)
Last Modified By	Writer
File Modified	2020-04-23
File Created	2026-10-30
Conversion State	complete

Extracted Text

COVID-19 Module
Long Term Care Facility: Staff and Personnel Impact 

NHSN Facility ID: 
CMS Certification Number (CCN):  
Facility Name:    

*Date for which responses are reported: ________/________/________

For the following questions, please collect data at the same time at least once a week (for example, 7 AM)


*Required for saving