Information Collection

57.144 - Long Term Care Respiratory Tract Infections (RTI) Module

IC 263459 under ICR 202310-0920-013 · OMB 0920-0666.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0666 can be found here:

Documents and Forms

Document Name Document Type
Form 57.144 57.144 - Long Term Care Respiratory Tract Infections (RTI) Module Form and Instruction
57.144 Long-Term Care RTI Module 57.144 Long-Term Care Respiratory Tract Infections (RTI) Module- Form.docx Form and Instruction
57.144 Long-Term Care RTI Module 57.144 Long-Term Care Respiratory Tract Infections (RTI) Module- Form.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	57.144 - Long Term Care Respiratory Tract Infections (RTI) Module	Agency IC Tracking Number:	0920-0666

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

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	57.144	Long-Term Care RTI Module	57.144 Long-Term Care Respiratory Tract Infections (RTI) Module- Form.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 16,500	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	396,000	396,000
Annual IC Time Burden (Hours)	165,000	165,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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