LTC Resident Impact - business operations occupations

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1290 can be found here:

Documents and Forms

Document Name Document Type
LTC Resident Impact - business operations occupations Form
Resdient impact and facility capactiy CDC 57.144_COVID-19 form_Resident Impact and Facility Capacity_v3_Ready for DEV 7.23.20.docx Form

Information Collection (IC) Details

IC Title:	LTC Resident Impact - business operations occupations	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Resdient impact and facility capactiy	CDC 57.144_COVID-19 form_Resident Impact and Facility Capacity_v3_Ready for DEV 7.23.20.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,446	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	63,596	0	63,596
Annual IC Time Burden (Hours)	37,098	15,899	21,199
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.