Long Term Care Facility Resident Impact and Facility Capacity Pathway

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

OMB: 0920-1317

IC ID: 243702

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

View Information Collection (IC)

Long Term Care Facility Resident Impact and Facility Capacity Pathway 0920-1317
 
No Removed
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CDC 57.144 Resident Impact and Facility Capacity 57.144 RIFC form v13 final 5.3.23_CLEAN.docx Yes Yes Fillable Fileable
Form and Instruction 57.144 COVID-19 and Respiratory Infections Module Long Term Care Facility Resident Impact and Facility Capacity Pathway Form (57.144) 07SEP2023 Form-COVID-19_Respiratory Infections Module LTCF_RIFC 57.144-Clean.docx N/A Yes Yes Fillable Fileable

Health Public Health Monitoring

 

16,500 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Requested 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 0 0 -858,000 0 0 858,000
Annual IC Time Burden (Hours) 0 0 -357,500 0 0 357,500
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
TOI - Form 57.144 TOI 57.144.docx 09/07/2023
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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