Resident Impact and Facility Capacity - State and Local Health Dept Occupations

National Healthcare Safety Network (NHSN) Coronavirus (COVID-19) Surveillance in Healthcare Facilities

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1317 can be found here:

Documents and Forms

Document Name Document Type
Form CDC 57.144 Resident Impact and Facility Capacity - State and Local Health Dept Occupations Form and Instruction
CDC 57.144 Resident Impact and Facility Capacity CDC 57.144_COVID-19 form_Resident Impact and Facility Capacity_v2 updated 6.2020 Final.docx Form and Instruction
CDC 57.144 Resident Impact and Facility Capacity CDC 57.144_COVID-19 form_Resident Impact and Facility Capacity_v2 updated 6.2020 Final.docx Form and Instruction
0920-1317 CDC 57.1 Resident Impact and Facility Capacity 57.144-LTCF_RIFC_V6.docx Form and Instruction
0920-1317 CDC 57.1 Resident Impact and Facility Capacity 57.144-LTCF_RIFC_V6.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Resident Impact and Facility Capacity - State and Local Health Dept Occupations	Agency IC Tracking Number:	0920-20LW

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CDC 57.144	Resident Impact and Facility Capacity	CDC 57.144_COVID-19 form_Resident Impact and Facility Capacity_v2 updated 6.2020 Final.docx		Yes	Yes	Fillable Fileable
Form and Instruction	0920-1317 CDC 57.144	Resident Impact and Facility Capacity	57.144-LTCF_RIFC_V6.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,870	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	97,240	97,240
Annual IC Time Burden (Hours)	72,930	72,930
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.