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Information Collection

State and Local Health Department - Resident Impact / Facility Capacity Form (Retrospective Datat Entry)

IC 241810 under ICR 202008-0920-012 · OMB 0920-1290.

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State and Local Health Department - Resident Impact / Facility Capacity Form (Retrospective Datat 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
   
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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