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Weekly Healthcare Personnel Influenza Vaccination Cumulative Summary for Long-Term Care Facilities

IC 246756 under ICR 202301-0920-005 · OMB 0920-0666.

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

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Weekly Healthcare Personnel Influenza Vaccination Cumulative Summary for Long-Term Care Facilities
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-0666 Weekly HCP Influenza Vaccination Cumulative Summary for Long-Term Care Facilities Weekly HCP Influenza Vaccination LTCF.docx NA Yes Yes Fillable Fileable

Health Health Care Services

 

1,200 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 62,400 0 0 0 0 62,400
Annual IC Time Burden (Hours) 62,400 0 0 0 0 62,400
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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