0920-1317 COVID-19 Hospital Data Form
[NCEZID] National Healthcare Safety Network (NHSN) Coronavirus (COVID-19) Surveillance in Healthcare Facilities
Form-COVID-19 Hospital Data Form-Clean Version
NHSN COVID-19 Hospital Module - Hospitals (excluding Psychiatric and Rehabilitation Facilities)
OMB: 0920-1317
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0920-1317 can be found here: