All Hazards

[NCEZID] The National Healthcare Safety Network (NHSN)

Documents and Forms

Document Name Document Type
Form 57.803 All Hazards Form and Instruction
57.803 All Hazards 57.803 All Hazards.docx Form and Instruction
0920-25-0119 57.803 Daily Facility Operating Status 57.803 Daily Facility Operating Status-Clean Version.docx Form
Change Memo 0920-0666-2.docx Change Request Memo IC Document

Information Collection (IC) Details

IC Title:	All Hazards	Agency IC Tracking Number:	0920-25-0119

Is this a Common Form? No		IC Status: Modified

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	57.803	All Hazards	57.803 All Hazards.docx		Yes	Yes	Fillable Fileable
Form	0920-25-0119	57.803 Daily Facility Operating Status	57.803 Daily Facility Operating Status-Clean Version.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 540	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	Previously Approved
Annual Number of Responses for this IC	197,100	197,100
Annual IC Time Burden (Hours)	16,425	16,425
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Change Request Memo	Change Memo 0920-0666-2.docx	05/15/2025

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