Information Collection Request

Emerging Infections Program Tracking of SARS-CoV-2 Infections among Healthcare Personnel

ICR 202009-0920-021 · OMB 0920-1296 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 0920-1296 Assessment of Healthcare Personnel Exposed to or Infected with SARS-CoV-2 06OCT2020 Form and Instruction Modified Available
Form 0920-1296 Assessment of Healthcare Personnel Exposed to or Infected with SARS-CoV-2: Denominator Form Form and Instruction Modified Available
Form 0920-20MZ EIP or State Health Dept Employee Form and Instruction Unchanged Available
Form 0920-20MZ Occupational Health Nurses at Healthcare Facilities Form Unchanged Available
Form 0920-1296 Assessment of Healthcare Personnel Exposed to or Infected with SARS-CoV-2 Case/Non-Case 25AUG2020 Form and Instruction Modified Available
Form 0920-1296 Assessment of Healthcare Personnel Exposed to or Infected with SARS-CoV-2 Form Form and Instruction Modified Available
Form 0920-1296 Assessment of Healthcare Personnel Exposed to or Infected with SARS-CoV-2 Possible Reinfection Form Form and Instruction Modified Available
Form 0920-20MZ Assessment of Healthcare Personnel Form and Instruction Modified Available
Att 1_EIP SARS-CoV-2 Infections among HCP Protocol 17SEP2020.docx Supplementary Document Uploaded 2020-10-06 Available
Non-sub change request template_EIP COVID HCP Project_09_18_2020.docx Justification for No Material/Nonsubstantive Change Uploaded 2020-10-06 Available
Non-sub change request template_EIP COVID HCP Project_08_19_2020.docx Justification for No Material/Nonsubstantive Change Uploaded 2020-08-25 Available
HCP Case Tracking Protocol_8_17_2020_changes in number of contact attempts.docx Supplementary Document Uploaded 2020-08-18 Available
Change Memo 0920-1296_v2.docx Justification for No Material/Nonsubstantive Change Uploaded 2020-07-24 Available
Attachment 4_Protocol_7_17_2020_CLEAN.docx Supplementary Document Uploaded 2020-07-24 Available
Emergency Review Request Memo - EIP Tracking of SARS-CoV-2 Infections among HCP_signed.pdf Supplementary Document Uploaded 2020-04-20 Available
Att5_Research Determination Form.pdf Supplementary Document Uploaded 2020-04-20 Available
Attachment3_Protocol omb_20200422.docx Supplementary Document Uploaded 2020-04-28 Available
Att1_Authorizing Legislation.docx Supplementary Document Uploaded 2020-04-20 Available
SSB_Tracking of HCP with COVID-19 omb_20200422.docx Supporting Statement B Uploaded 2020-04-28 Available
SSA_Tracking of HCP with COVID-19 omb_20200422.docx Supporting Statement A Uploaded 2020-04-28 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
242771 Occupational Health Nurses at Healthcare Facilities -Assessment of Healthcare Personnel Exposed to or Infected with SARS-CoV-2: Denominator Form Form and Instruction ModifiedAssessment of Healthcare Personnel Exposed to or Infected with SARS-CoV-2 06OCT2020
242771 Occupational Health Nurses at Healthcare Facilities -Assessment of Healthcare Personnel Exposed to or Infected with SARS-CoV-2: Denominator Form Form and Instruction ModifiedAssessment of Healthcare Personnel Exposed to or Infected with SARS-CoV-2: Denominator Form
241587 EIP or State Health Dept Employee Form and Instruction UnchangedEIP or State Health Dept Employee
241437 Occupational Health Nurses at Healthcare Facilities (no form) Form UnchangedOccupational Health Nurses at Healthcare Facilities
241429 Assessment of Healthcare Personnel Exposed to or Infected with SARS-CoV-2 Form and Instruction ModifiedAssessment of Healthcare Personnel Exposed to or Infected with SARS-CoV-2 Case/Non-Case 25AUG2020
241429 Assessment of Healthcare Personnel Exposed to or Infected with SARS-CoV-2 Form and Instruction ModifiedAssessment of Healthcare Personnel Exposed to or Infected with SARS-CoV-2 Form
241429 Assessment of Healthcare Personnel Exposed to or Infected with SARS-CoV-2 Form and Instruction ModifiedAssessment of Healthcare Personnel Exposed to or Infected with SARS-CoV-2 Possible Reinfection Form
241429 Assessment of Healthcare Personnel Exposed to or Infected with SARS-CoV-2 Form and Instruction ModifiedAssessment of Healthcare Personnel

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
10/31/2020 10/31/2020 10/31/2020
5,620 0 5,620
2,543 0 2,543
0 0 0





Reginfo record details
4
table that charts list of burden
IC Title Form No. Form Name
Assessment of Healthcare Personnel Exposed to or Infected with SARS-CoV-2 0920-20MZ, 0920-1296, 0920-1296, 0920-1296 ,   ,   ,  
EIP or State Health Dept Employee 0920-20MZ
Occupational Health Nurses at Healthcare Facilities (no form) 0920-20MZ
Occupational Health Nurses at Healthcare Facilities -Assessment of Healthcare Personnel Exposed to or Infected with SARS-CoV-2: Denominator Form 0920-1296, 0920-1296 ,  

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 5,620 5,620 0 0 0 0
Annual Time Burden (Hours) 2,543 2,543 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No