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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
OMB.report
HHS/CDC
OMB 0920-1317
ICR 202404-0920-010
IC 247668
( )
⚠️ Notice: This information collection may be referencing outdated material.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
Documents and Forms
Document Name
Document Type
Form 0920-1317
VA - Resident COVID-19 Event Form - LTCF
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
Form and Instruction
Clean 10.1.4 SVH COVID-19 Resident toi_V9_7.22.docx
INSTRUCTIONS - Resident COVID-19 Event Form JUL2022
IC Document
Information Collection (IC) Details
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