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Monthly Reporting Plan form for Long-term Care Facilities
[NCEZID] National Healthcare Safety Network (NHSN) Coronavirus (COVID-19) Surveillance in Healthcare Facilities
OMB: 0920-1317
IC ID: 249437
OMB.report
HHS/CDC
OMB 0920-1317
ICR 202404-0920-010
IC 249437
( )
⚠️ Notice: This information collection may be referencing outdated material.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 CDC Form 57.141
Monthly Reporting Plan form for Long-term Care Facilities
Form and Instruction
CDC Form 57.141 Monthly Reporting Plan for LTCF
57.141_ReportPlan_LTCF_July2021.docx
Form and Instruction
Information Collection (IC) Details
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