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Federal forms, ICRs, and supporting documents

Information Collection

COVID-19 Supplies Form - State and Local Health Department

IC 241303 under ICR 202008-0920-012 · OMB 0920-1290.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Form 0920-1290
COVID-19 Supplies Form - State and Local Health Department		 Form and Instruction
0920-1290 COVID-19 Supplies Form
Att8_NHSN COVID-19 Supplies Form .docx 		Form and Instruction
0920-1290 COVID-19 Module Hospital Supply Pathway 01JUL2020
57.132_v2cCOVID-19_SUP 06122020 FINAL.docx 		Form and Instruction
TOI_57.132_v2bCOVI-19 SUP_06122020 Final .docx
Instructions - Hospital Supply Pathway Form		IC Document

Information Collection (IC) Details

View Information Collection (IC)

layout table

Information Collection Instruments:
table that charts list of 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 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

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  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 0 0 0 46,710
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
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.