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Staff and Personnel Impact - State and Local Health Dept Occupations retrospective
[NCEZID] National Healthcare Safety Network (NHSN) Coronavirus (COVID-19) Surveillance in Healthcare Facilities
OMB: 0920-1317
IC ID: 243711
OMB.report
HHS/CDC
OMB 0920-1317
ICR 202305-0920-005
IC 243711
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1317 can be found here:
2024-08-06 - No material or nonsubstantive change to a currently approved collection
2024-04-26 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Form CDC 57.145
Staff and Personnel Impact - State and Local Health Dept Occupations retrospective
Form and Instruction
CDC 57.145 Staff and Personnel Impact
57.145 Staff and Personnel Form v5_CLEAN.docx
Form and Instruction
CDC 57.145 Staff and Personnel Impact
57.145 Staff and Personnel Form v5_CLEAN.docx
Form and Instruction
57.145- staff toi V8_CLEAN.docx
Form Instructions
IC Document
57.145- staff toi V8_CLEAN.docx
Form Instructions
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Staff and Personnel Impact - State and Local Health Dept Occupations retrospective
Agency IC Tracking Number:
0920-1317
Is this a Common Form?
No
IC Status:
Modified
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 57.145
Staff and Personnel Impact
57.145 Staff and Personnel Form v5_CLEAN.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
935
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
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
935
0
0
0
0
935
Annual IC Time Burden (Hours)
78
0
-156
0
0
234
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Form Instructions
57.145- staff toi V8_CLEAN.docx
05/18/2023
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.