57.102 - Hospital Respiratory Data Form (Daily - user entry)

[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⚠️ Notice: This information collection may be referencing outdated material.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 57.102 57.102 - Hospital Respiratory Data Form (Daily - user entry) Form and Instruction
Form 57.102 57.102 - Hospital Respiratory Data Form (Daily - user entry) Form and Instruction
57.102 Hospital Respiratory Data Daily Reporting Form 57.102 Hospital Respiratory Data Form - Daily Reporting - Clean Version.docx Form and Instruction
57.102 Hospital Respiratory Data Daily Reporting Form 14AUG2024 57.102 Hospital Respiratory Data Form - Daily Reporting - Clean Version.docx Form and Instruction

Information Collection (IC) Details

IC Title:	57.102 - Hospital Respiratory Data Form (Daily - user entry)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	57.102	Hospital Respiratory Data Daily Reporting Form 14AUG2024	57.102 Hospital Respiratory Data Form - Daily Reporting - Clean Version.docx	N/A	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 492	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	179,580	179,580
Annual IC Time Burden (Hours)	173,594	173,594
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.