Dialysis Component

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

OMB: 0920-1317

IC ID: 243719

Information Collection (IC) Details

View Information Collection (IC)

Dialysis Component 0920-20LW
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-20LW Dialysis Component covid19 dialysis outpatient module_v6_08112020 (002)kab final.docx Yes Yes Fillable Fileable
Form and Instruction 0920-1317 COVID-19 Module Dialysis Outpatient Facility Dialysis COVID 19 Reporting Form Clean.docx NA Yes Yes Fillable Fileable
Form and Instruction 0920-1317 COVID-19 Module Dialysis Outpatient Facility Form 27MAY2021 Dialysis COVID 19 Reporting Form Final 9.5.4 Release.docx NA Yes Yes Fillable Fileable

Health Public Health Monitoring

 

7,900 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 821,600 0 312,000 0 0 509,600
Annual IC Time Burden (Hours) 342,333 0 172,466 0 0 169,867
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Instructions for Dialysis Outpatient Facility COVID-19 Module 27MAY2021 COVID Dialysis Module TOIs for Users 9.5.4 Release_Final.docx 05/27/2021
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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