COVID-19 Supplies Form - State and Local Health Department

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

OMB: 0920-1290

IC ID: 241303

Information Collection (IC) Details

View Information Collection (IC)

COVID-19 Supplies Form - State and Local Health Department
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-1290 COVID-19 Supplies Form Att8_NHSN COVID-19 Supplies Form .docx NA Yes Yes Fillable Fileable
Form and Instruction 0920-1290 COVID-19 Module Hospital Supply Pathway 01JUL2020 57.132_v2cCOVID-19_SUP 06122020 FINAL.docx NA Yes Yes Fillable Fileable

Health Health Care Services

 

519 0
   
State, Local, and Tribal Governments
 
   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 93,420 0 0 0 0 93,420
Annual IC Time Burden (Hours) 46,710 0 7,785 0 0 38,925
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Instructions - Hospital Supply Pathway Form TOI_57.132_v2bCOVI-19 SUP_06122020 Final .docx 07/01/2020
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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