Information Collection

Staff and Personnel Impact - LTCF Personnel

IC 243706 under ICR 202207-0920-002 · OMB 0920-1317.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CDC 57.145 Staff and Personnel Impact - LTCF Personnel	Form and Instruction
Form CDC 57.145 Staff and Personnel Impact Staff and Personnel Impact - LTCF Personnel	Form and Instruction
Form 0920-1317 / CDC 57 Staff and Personnel Impact Form 23MAY2022 Staff and Personnel Impact - LTCF Personnel	Form and Instruction
CDC 57.145 Staff and Personnel Impact CDC 57.145_COVID-19 form_Staff and Personnel Impactword Final.docx	Form and Instruction
CDC 57.145 Staff and Personnel Impact CDC 57.145_COVID-19 form_Staff and Personnel Impactword Final.docx	Form and Instruction
0920-1317 / CDC 57 Staff and Personnel Impact Form 23MAY2022 57.145 Staff and Personnel Form 10.1.3 OMB.docx	Form and Instruction
0920-1317 / CDC 57 Staff and Personnel Impact Form 23MAY2022 57.145 Staff and Personnel Form 10.1.3 OMB.docx	Form and Instruction
57.145- staff and personnel toi V4 10.1.3 OMB.docx Staff and Personnel Impact Form - Instructions	IC Document
57.145- staff and personnel toi V4 10.1.3 OMB.docx Staff and Personnel Impact Form - Instructions	IC Document

IC Title:

Staff and Personnel Impact - LTCF Personnel

Agency IC Tracking Number:

0920-20LW

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CDC 57.145	Staff and Personnel Impact	CDC 57.145_COVID-19 form_Staff and Personnel Impactword Final.docx		Yes	Yes	Fillable Fileable
Form and Instruction	0920-1317 / CDC 57.145	Staff and Personnel Impact Form 23MAY2022	57.145 Staff and Personnel Form 10.1.3 OMB.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: 11,621

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	604,292	604,292
Annual IC Time Burden (Hours)	100,715	100,715
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Staff and Personnel Impact Form - Instructions	57.145- staff and personnel toi V4 10.1.3 OMB.docx	05/23/2022

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