OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Business and Financial Operations Occupations - Resident Impact/Facility Capacity Form - Retrospective Data Entry

IC 241809 under ICR 202008-0920-012 · OMB 0920-1290.

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

View Information Collection (IC)

Business and Financial Operations Occupations - Resident Impact/Facility Capacity Form - 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 Resident Impact and Facility Capacity Form (Retrospective Datat Entry) CDC 57.144_TOI_Resident Impact and Facility Capacity (OMB) (002) lw CLEAN.docx NA Yes Yes Fillable Fileable

Health Health Care Services

 

1,223 0
   
Individuals or Households
 
   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

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.