NHSN COVID-19 Long Term Care Facility (LTCF) Module - LTCF Personnel

Emergency Extension - National Healthcare Safety Network (NHSN) Patient Impact Module for Coronavirus (COVID-19) Surveillance in Healthcare Facilities

OMB: 0920-1306

IC ID: 244087

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

View Information Collection (IC)

NHSN COVID-19 Long Term Care Facility (LTCF) Module - LTCF Personnel
 
No Unchanged
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 57.155 NHSN - Point of Care Testing Results -LTCF personnel (reporting staff test results) 57.XXX_Point of Care Testing Final 10 15 20.docx NA Yes Yes Fillable Fileable
Form and Instruction 57.155 NHSN - Point of Care Testing Results - LTCF personnel (reporting resident test results) 57.XXX_Point of Care Testing Final 10 15 20.docx NA Yes Yes Fillable Fileable

Health Public Health Monitoring

 

6,800 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 1,098,200 0 0 0 0 1,098,200
Annual IC Time Burden (Hours) 137,275 0 0 0 0 137,275
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Instructions - POC Form 57.155 Table of Instructions for Point of Care Testing (POC) Form 10 15 20.docx 10/15/2020
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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