Staff and Personnel Impact - State and Local Health Dept Occupations retrospective

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

⚠️ Notice: This information collection may be referencing outdated material.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

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

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

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 Agency Discretion	Previously Approved
Annual Number of Responses for this IC	935	0	935
Annual IC Time Burden (Hours)	78	-156	234
Annual IC Cost Burden (Dollars)	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.