Seasonal Survey on Influenza Vaccination Programs for Healthcare Personnel

[NCEZID] The National Healthcare Safety Network (NHSN)

Documents and Forms

Document Name Document Type
Form 57.215 Seasonal Survey on Influenza Vaccination Programs for Healthcare Personnel Form and Instruction
57.215 Seasonal Survey on Influenza Vaccination Programs for He 57.215 Seasonal Survey on Influenza Vaccination Programs for Healthcare Personnel.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Seasonal Survey on Influenza Vaccination Programs for Healthcare Personnel	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	57.215	Seasonal Survey on Influenza Vaccination Programs for Healthcare Personnel	57.215 Seasonal Survey on Influenza Vaccination Programs for Healthcare Personnel.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 15,426	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 Agency Discretion
Annual Number of Responses for this IC	15,426	15,426
Annual IC Time Burden (Hours)	11,570	11,570
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.