Information Collection

[NCEZID] Survey for Soliciting Feedback on NHSN Hemovigilance Module User Experience

IC 277268 under ICR 202409-0920-009 · OMB 0920-1071.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1050 Survey of All Facilities Enrolled in NHSN HV Module - Pre-Survey [NCEZID] Survey for Soliciting Feedback on NHSN Hemovigilance Module User Experience	Form and Instruction
Form 0920-1050 Survey of All Facilities Enrolled in NHSN HV Module - Post-Survey [NCEZID] Survey for Soliciting Feedback on NHSN Hemovigilance Module User Experience	Form and Instruction
0920-1050 Survey of All Facilities Enrolled in NHSN HV Module - Pr Att A - NHSN HV Module Facility Survey (Pre-Survey Sept 2025).docx	Form and Instruction
0920-1050 Survey of All Facilities Enrolled in NHSN HV Module - Po Att B - NSHN HV Module Facility Survey (Post-Survey -Jan 2027).docx	Form and Instruction
Att C - NHSN HV Module Survey - Email Solicitation.docx NHSN HV Module Survey - Email Solicitation	IC Document
Service Delivery Fast Track Template - BOOTS.docx 0920-1071 GenIC Request Template	IC Document

IC Title:

Agency IC Tracking Number:

0920-25-0161

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-1050			N/A	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1050			N/A	Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 720

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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	720	720
Annual IC Time Burden (Hours)	120	120
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
NHSN HV Module Survey - Email Solicitation		08/26/2025
0920-1071 GenIC Request Template		08/26/2025

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

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