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Occupational Health Nurses at Healthcare Facilities -Assessment of Healthcare Personnel Exposed to or Infected with SARS-CoV-2: Denominator Form

IC 242771 under ICR 202009-0920-021 · OMB 0920-1296.

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Document Type
Form and Instruction
Form and Instruction
Form and Instruction
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Occupational Health Nurses at Healthcare Facilities -Assessment of Healthcare Personnel Exposed to or Infected with SARS-CoV-2: Denominator Form
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-1296 Assessment of Healthcare Personnel Exposed to or Infected with SARS-CoV-2: Denominator Form Attachment 3_Denominator Form_07_17_2020_CLEAN.docx NA Yes Yes Fillable Fileable
Form and Instruction 0920-1296 Assessment of Healthcare Personnel Exposed to or Infected with SARS-CoV-2 06OCT2020 Att 3_HCP Exposed_Infected with SARS-CoV-2_Denominator Form.docx NA Yes Yes Fillable Fileable

Health Public Health Monitoring

 

50 0
   
Private Sector Businesses or other for-profits
 
   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 300 0 0 0 0 300
Annual IC Time Burden (Hours) 100 0 0 0 0 100
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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