VA - Resident COVID-19 Event Form - LTCF

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

OMB: 0920-1317

IC ID: 247668

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

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VA - Resident COVID-19 Event Form - LTCF 0920-1317
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-1317 VA COVID-19 Resident Event Form Clean 10.1.4 COVID 19 event reporting_resident form revised_7.22.docx NA Yes Yes Fillable Fileable

Health Public Health Monitoring

 

188 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 6,768 0 0 0 0 6,768
Annual IC Time Burden (Hours) 3,948 0 0 0 0 3,948
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
INSTRUCTIONS - Resident COVID-19 Event Form JUL2022 Clean 10.1.4 SVH COVID-19 Resident toi_V9_7.22.docx 11/29/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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