Information Collection

Weekly Healthcare Personnel Influenza Vaccination Cumulative Summary for Non-Long-Term Care Facilities (CSV)

IC 272101 under ICR 202410-0920-013 · OMB 0920-0666.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0666 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 57.211 Weekly Healthcare Personnel Influenza Vaccination Cumulative Summary for Non-Long-Term Care Facilities (CSV)	Form
57.211 CSV Submission 57.211 CSV Submission.docx	Form
57.211 CSV Submission 57.211 CSV Submission.docx	Form
57.211 Healthcare Personnel Influenza Vaccination Cumulative Summary for Non-LTCF.docx Form Information only	IC Document
57.211 Healthcare Personnel Influenza Vaccination Cumulative Summary for Non-LTCF.docx Form Information only	IC Document

IC Title:

Weekly Healthcare Personnel Influenza Vaccination Cumulative Summary for Non-Long-Term Care Facilities (CSV)

Agency IC Tracking Number:

0920-0666

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

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	57.211	CSV Submission	57.211 CSV Submission.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,080

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	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	36,960	35,556	1,404
Annual IC Time Burden (Hours)	12,320	11,735	585
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Form Information only	57.211 Healthcare Personnel Influenza Vaccination Cumulative Summary for Non-LTCF.docx	11/04/2024

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.