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Federal forms, ICRs, and supporting documents

Information Collection

State and Local Health Departments - Staff and Personnel Impact - Retrospective Data Entry

IC 241807 under ICR 202008-0920-012 · OMB 0920-1290.

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Document Name
Document Type
Form and Instruction
Form and Instruction
Information Collection (IC) Details

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State and Local Health Departments - Staff and Personnel Impact - Retrospective Data Entry
 
No Unchanged
 
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 Module - LTCF Staff and Personnel Impact Form (Retrospective Datat Entry) CDC 57.145_TOI_Staff and Personnel Impact lw CLEAN.docx NA Yes Yes Fillable Fileable

Health Health Care Services

 

1,223 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 1,223 0 0 0 0 1,223
Annual IC Time Burden (Hours) 306 0 0 0 0 306
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.