Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities

[NCEZID] National Healthcare Safety Network (NHSN) Coronavirus (COVID-19) Surveillance in Healthcare Facilities

OMB: 0920-1317

IC ID: 249436

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities 0920-1317
 
No Unchanged
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-1317 / CDC Form 57.509 Weekly COVID-19 Vaccination Cumulative Summary for Dialysis Patients COVIDVax.Dialysis.FORM_September2021_ARB.EK.docx NA Yes Yes Fillable Fileable

Health Public Health Monitoring

 

7,700 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 400,400 0 0 0 0 400,400
Annual IC Time Burden (Hours) 500,500 0 0 0 0 500,500
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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