COVID-19 Healthcare Worker Form - Microbiologist

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

Documents and Forms

Document Name Document Type
Form 0920-1290 COVID-19 Healthcare Worker Form - Microbiologist Form and Instruction
0920-1290 COVID-19 Healthcare Worker Form Att7_NHSN COVID-19 Module Healthcare Worker Staffing Form.docx Form and Instruction

Information Collection (IC) Details

IC Title:	COVID-19 Healthcare Worker Form - Microbiologist	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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 and Instruction	0920-1290	COVID-19 Healthcare Worker Form	Att7_NHSN COVID-19 Module Healthcare Worker Staffing Form.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,079	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	374,220	374,220
Annual IC Time Burden (Hours)	155,925	155,925
Annual IC Cost Burden (Dollars)	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.