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Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents (.csv)
[NCEZID] National Healthcare Safety Network (NHSN) Coronavirus (COVID-19) Surveillance in Healthcare Facilities
OMB: 0920-1317
IC ID: 270310
OMB.report
HHS/CDC
OMB 0920-1317
ICR 202410-0920-012
IC 270310
( )
Documents and Forms
Document Name
Document Type
Form 57.216
Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents (.csv)
Form and Instruction
57.216 Optional Person Level Reporting of Weekly COVID-19 Vacci
57.216 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents (.csv)
Agency IC Tracking Number:
0920-1317
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
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
57.216
Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents
57.216 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents.docx
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:
167
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
8,684
0
0
0
0
8,684
Annual IC Time Burden (Hours)
8,973
0
289
0
0
8,684
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.