OMB
.report
Search
57.102 - Hospital Respiratory Data Form (Daily - user entry)
[NCEZID] National Healthcare Safety Network (NHSN) Coronavirus (COVID-19) Surveillance in Healthcare Facilities
OMB: 0920-1317
IC ID: 269866
OMB.report
HHS/CDC
OMB 0920-1317
ICR 202410-0920-012
IC 269866
( )
Documents and Forms
Document Name
Document Type
Form 57.102
57.102 - Hospital Respiratory Data Form (Daily - user entry)
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
View Information Collection (IC)
IC Title:
57.102 - Hospital Respiratory Data Form (Daily - 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
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
Federal Enterprise Architecture Business Reference Module
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 %
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
179,580
0
0
0
0
179,580
Annual IC Time Burden (Hours)
173,594
0
0
0
0
173,594
Annual IC Cost Burden (Dollars)
0
0
0
0
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.