57.101 Hospital Respiratory Data Form (Weekly - User Entry)

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

Documents and Forms

Document Name Document Type
Form 0920-1317 57.101 Hospital Respiratory Data Form (Weekly - User Entry) Form and Instruction
0920-1317 Hospital Respiratory Data Weekly Reporting Form 57.101 Hospital Respiratory Data Form - Weekly Reporting - Clean Version.docx Form and Instruction

Information Collection (IC) Details

IC Title:	57.101 Hospital Respiratory Data Form (Weekly - User Entry)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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	0920-1317	Hospital Respiratory Data Weekly Reporting Form	57.101 Hospital Respiratory Data Form - Weekly 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: 1,148	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	59,696	59,696
Annual IC Time Burden (Hours)	200,977	200,977
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.