Information Collection

57.509 Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities-.CSV

IC 271950 under ICR 202410-0920-012 · OMB 0920-1317.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1317 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 57.509 57.509 Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities-.CSV	Form and Instruction
57.509 57.509 Weekly COVID-19 Vaccination Cumulative Summary fo 57.509 Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities.docx	Form and Instruction
57.509 57.509 Weekly COVID-19 Vaccination Cumulative Summary fo 57.509 Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities.docx	Form and Instruction

IC Title:

57.509 Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities-.CSV

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

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	57.509	57.509 Weekly COVID-19 Vaccination Cumulative Summary for Dialysis Patients_CSV	57.509 Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities.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: 2,802

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	33,624	33,624
Annual IC Time Burden (Hours)	22,416	22,416
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.