State and Local Health Department occupations - Resident Impact and Facility Capacity form (57.144)

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

OMB: 0920-1306

IC ID: 244445

Information Collection (IC) Details

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State and Local Health Department occupations - Resident Impact and Facility Capacity form (57.144)
 
No New
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 57.144 Resident Impact and Facility Capacity form (57.144) 57.144-RIFC Form_V5_OMB Submission CLEAN__10.30.20.docx NA Yes Yes Fillable Fileable

Health Public Health Monitoring

 

1,870 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 97,240 0 97,240 0 0 0
Annual IC Time Burden (Hours) 72,930 0 72,930 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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