LTCF - Staff and Personnel Impact form (57.145) - Retrospective Data Entry

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

OMB: 0920-1306

IC ID: 244452

Information Collection (IC) Details

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LTCF - Staff and Personnel Impact form (57.145) - Retrospective Data Entry
 
No New
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 57.145 Staff and Personnel Impact form (57.145) 57.145-staff and personnel Form_V2_OMB Version CLEAN_10.30.20.docx NA Yes Yes Fillable Fileable

Health Public Health Monitoring

 

5,811 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 5,811 0 5,811 0 0 0
Annual IC Time Burden (Hours) 1,937 0 1,937 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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