[NCEZID] National Healthcare Safety Network (NHSN) Respiratory Data

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 57.510 57.510 COVID–19 Module Dialysis Outpatient Facility-.csv	Form and Instruction	Unchanged	Available
Form 57.509 57.509 - Weekly COVID-19 Vaccination Cumulative Summary for Dialysis Patients - 11FEB2026	Form and Instruction	Modified	Available
Form 57.509 57.509 Weekly COVID-19 Vaccination Cumulative Summary for Dialysis Patients_CSV	Form and Instruction	Modified	Available
Form 0920-1317 Point of Care Testing Results - 11FEB2026	Form and Instruction	Modified	Available
Form 57.155 Point of Care Testing Results	Form and Instruction	Modified	Available
Form 57.219 57.219 Healthcare Personnel COVID-19 Vaccination Cumulative Summary_25SEP2025	Form and Instruction	Unchanged	Available
Form 57.219 Healthcare Personnel COVID-19 Vaccination Cumulative Summary	Form and Instruction	Unchanged	Available
Form 57.218 57.218 - Weekly Respiratory Pathogen and Vaccination Summary for Residents of LTCF - 11FEB2026	Form	Modified	Available
Form 57.218 57.218 Weekly Respiratory Pathogen and Vaccination Summary for Residents of LTCF_25SEP2025	Form and Instruction	Modified	Available
Form 57.218 Weekly Respiratory Pathogen and Vaccination Summary for Residents of LTCF (.csv)	Form and Instruction	Modified	Available
Form 57.218 Weekly Respiratory Pathogen and Vaccination Summary for Residents of Long-Term Care Facilities	Form and Instruction	Modified	Available
Form 57.217 57.217 - Optional Person-Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel - 11FEB2026	Form and Instruction	Modified	Available
Form 57.217 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel 29SEP2025	Form and Instruction	Modified	Available
Form 57.217 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel	Form and Instruction	Modified	Available
Form 57.217 57.217 - Optional Person-Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel - 11FEB2026	Form and Instruction	Modified	Available
Form 57.217 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel_29SEP2025	Form and Instruction	Modified	Available
Form 57.217 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel	Form and Instruction	Modified	Available
Form 57.216 57.216 - Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents - 11FEB2026	Form and Instruction	Modified	Available
Form 57.216 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents Form 57.216_rev 29SEP2025	Form and Instruction	Modified	Available
Form 57.216 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents	Form and Instruction	Modified	Available
Form 57.216 57.216 - Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents - 11FEB2026	Form and Instruction	Modified	Available
Form 57.216 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents Form 57.216_rev 29SEP2025	Form and Instruction	Modified	Available
Form 57.216 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents	Form and Instruction	Modified	Available
Form 57.102 Hospital Respiratory Data Daily Reporting Form 14AUG2024	Form and Instruction	Unchanged	Available
Form 57.102 Hospital Respiratory Data Daily Reporting Form 14AUG2024	Form and Instruction	Unchanged	Available
Form 57.102 Hospital Respiratory Data Daily Reporting Form 14AUG2024	Form and Instruction	Unchanged	Available
Form 0920-1317 Hospital Respiratory Data Weekly Reporting Form	Form and Instruction	Unchanged	Available
Form 0920-1317 Hospital Respiratory Data Weekly Reporting Form	Form and Instruction	Unchanged	Available
Form 0920-1317 Hospital Respiratory Data Weekly Reporting Form	Form and Instruction	Unchanged	Available
Form 57.155 Point of Care Testing Results - 11FEB2026	Form and Instruction	Modified	Available
Form 57.155 Point of Care Testing Results	Form and Instruction	Modified	Available
Form 57.509 57.509 - Weekly COVID-19 Vaccination Cumulative Summary for Dialysis Patients - 11FEB2026	Form and Instruction	Modified	Available
Form 57.509 Weekly COVID-19 Vaccination Cumulative Summary for Dialysis Patients_Manual	Form and Instruction	Modified	Available
Form 57.218 57.218 - Weekly Respiratory Pathogen and Vaccination Summary for Residents of LTCF - 11FEB2026	Form and Instruction	Modified	Available
Form 57.218 57.218 Weekly Respiratory Pathogen and Vaccination Summary for Residents of LTCF_25SEP2025	Form and Instruction	Modified	Available
Form 57.218 Weekly Respiratory Pathogen and Vaccination Summary for Residents of LTCF (manual)	Form and Instruction	Modified	Available
Form Form 57.218 Weekly Respiratory Pathogen and Vaccination Summary for Residents of Long-Term Care Facilities (manual)	Form and Instruction	Modified	Available
Form 57.219 57.219 Healthcare Personnel COVID-19 Vaccination Cumulative Summary	Form and Instruction	Unchanged	Available
Form 57.219 Healthcare Personnel COVID-19 Vaccination Cumulative Summary	Form and Instruction	Unchanged	Available
Form 57.510 COVID–19 Module - Dialysis Outpatient Facility	Form and Instruction	Unchanged	Available
Form 57.140 NHSN Registration Form	Form and Instruction	Modified	Available
SSB 0920-1317 NHSN Respiratory Data.docx	Supporting Statement B	Uploaded 2026-02-11	Available
SSA 0920-1317 NHSN Respiratory Data Package.docx	Supporting Statement A	Uploaded 2026-02-11	Available
G3. NHSN2-Cloud_PIA_Signed_2023-12-05_eRAP.pdf	Supplementary Document	Uploaded 2026-02-10	Available
G2. NHSN_PIA_Signed_2023-01-19.pdf	Supplementary Document	Uploaded 2026-02-10	Available
G1. Privacy Impact Assessment.pdf	Supplementary Document	Uploaded 2026-02-10	Available
E3. Human Subjects Determination.pdf	Supplementary Document	Uploaded 2026-02-10	Available
D2. Explanation for Program Changes or Adjustments 2025-0920-1317.docx	Supplementary Document	Uploaded 2026-02-10	Available
D1. Explanation for Program Changes or Adjustments.docx	Supplementary Document	Uploaded 2026-02-10	Repair queued
B1. Published 60-day FRN.pdf	Supplementary Document	Uploaded 2026-02-10	Available
B5. Response to Commment_2.pdf	Public Comments	Uploaded 2025-08-14	Available
B4. Comment 2_Attachment_GNYHA.pdf	Public Comments	Uploaded 2025-08-14	Available
B3. Response to Commment_1.pdf	Public Comments	Uploaded 2025-08-13	Available
B2. Comment_1_Attachment_AHCA Comments on CDC PRA 60 Day_25_0023_Final.pdf	Public Comments	Uploaded 2025-08-13	Available
Change Memo 0920-1317 September 2025 FINAL_30SEP2025.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-09-30	Available
Change Request Memo - EO14168.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-03-04	Available
Change Memo 0920-1317 December 2024.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-01-09	Available
D. Explanation for Program Changes or Adjustments.docx	Supplementary Document	Uploaded 2024-10-29	Available
G2. Privacy Impact Assessment.pdf	Supplementary Document	Uploaded 2024-10-29	Available
G1. Privacy Impact Assessment.pdf	Supplementary Document	Uploaded 2024-10-29	Available
G. Privacy Impact Assessment.pdf	Supplementary Document	Uploaded 2024-10-29	Available
E3. Human Subjects Determination.pdf	Supplementary Document	Uploaded 2024-10-29	Available
B. FRN-60 day.pdf	Supplementary Document	Uploaded 2024-10-29	Available
Change Memo 0920-1317 August 2024_FINAL_v2.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2024-08-22	Available
Change Memo 0920-1317.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2024-08-06	Available
Change Request Memo NHSN COVID-19 0920-1317_26APR2024 v2.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2024-04-26	Available
Change Memo for CDC NHSN COVID-19 OMB Package 0920-1317.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2024-03-14	Available
Resident Impact and Facility Capacity- csv temp..csv	Supplementary Document	Uploaded 2023-09-07	Available
TOI-Facility Importing COVID-19 and Respiratory Infections using a .csv file_RIFC.docx	Supplementary Document	Uploaded 2023-09-07	Available
Change Memo for NHSN September 2023_0920_1317.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2023-09-07	Available
Crosswalk_57.218.docx	Supplementary Document	Uploaded 2023-09-07	Available
Crosswalk_57.144.docx	Supplementary Document	Uploaded 2023-09-07	Available
Crosswalk-COVID-19 Hospital Data.docx	Supplementary Document	Uploaded 2023-09-07	Available
Crosswalk 11.4 updated COVID JUNE_final.docx	Supplementary Document	Uploaded 2023-05-18	Available
Change Memo for NHSN May 2023_0920_1317_final.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2023-05-18	Available
CDC Response to APIC Dec29 letter sk lw.docx	Supplementary Document	Uploaded 2023-03-06	Available
5. NHSN - Report of End of Human Research Review 0.1253.docx	Supplementary Document	Uploaded 2022-11-28	Available
6. IRB Protocol Closure.pdf	Supplementary Document	Uploaded 2022-11-28	Available
3. Privacy Act Checklist 2022.docx	Supplementary Document	Uploaded 2022-11-28	Available
1c. 42 USC 242m.PDF	Supplementary Document	Uploaded 2022-11-28	Available
1b. 42 USC 242k.PDF	Supplementary Document	Uploaded 2022-11-28	Available
1a. 42 USC 242b.PDF	Supplementary Document	Uploaded 2022-11-28	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
271955	57.510 COVID–19 Module Dialysis Outpatient Facility-CSV	Form and Instruction	Unchanged	57.510 COVID–19 Module Dialysis Outpatient Facility-.csv
271955	57.510 COVID–19 Module Dialysis Outpatient Facility-CSV	Form and Instruction	Unchanged
271950	57.509 Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities-.CSV	Form and Instruction	Modified	57.509 - Weekly COVID-19 Vaccination Cumulative Summary for Dialysis Patients - 11FEB2026
271950	57.509 Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities-.CSV	Form and Instruction	Modified	57.509 Weekly COVID-19 Vaccination Cumulative Summary for Dialysis Patients_CSV
271950	57.509 Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities-.CSV	Form and Instruction	Modified
271935	57.155 Point of Care Testing Results - CSV	Form and Instruction	Modified	Point of Care Testing Results - 11FEB2026
271935	57.155 Point of Care Testing Results - CSV	Form and Instruction	Modified	Point of Care Testing Results
271935	57.155 Point of Care Testing Results - CSV	Form and Instruction	Modified
270333	Weekly Healthcare Personnel COVID-19 Vaccination Cumulative Summary (.csv)	Form and Instruction	Unchanged	57.219 Healthcare Personnel COVID-19 Vaccination Cumulative Summary_25SEP2025
270333	Weekly Healthcare Personnel COVID-19 Vaccination Cumulative Summary (.csv)	Form and Instruction	Unchanged	Healthcare Personnel COVID-19 Vaccination Cumulative Summary
270333	Weekly Healthcare Personnel COVID-19 Vaccination Cumulative Summary (.csv)	Form and Instruction	Unchanged
270316	57.218 Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities (.csv)	Form	Modified	57.218 - Weekly Respiratory Pathogen and Vaccination Summary for Residents of LTCF - 11FEB2026
270316	57.218 Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities (.csv)	Form and Instruction	Modified	57.218 Weekly Respiratory Pathogen and Vaccination Summary for Residents of LTCF_25SEP2025
270316	57.218 Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities (.csv)	Form and Instruction	Modified	Weekly Respiratory Pathogen and Vaccination Summary for Residents of LTCF (.csv)
270316	57.218 Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities (.csv)	Form and Instruction	Modified	Weekly Respiratory Pathogen and Vaccination Summary for Residents of Long-Term Care Facilities
270316	57.218 Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities (.csv)	Form and Instruction	Modified
270313	57.217 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel (.csv)	Form and Instruction	Modified	57.217 - Optional Person-Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel - 11FEB2026
270313	57.217 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel (.csv)	Form and Instruction	Modified	Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel 29SEP2025
270313	57.217 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel (.csv)	Form and Instruction	Modified	Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel
270313	57.217 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel (.csv)	Form and Instruction	Modified
270312	57.217 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel (manual)	Form and Instruction	Modified	57.217 - Optional Person-Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel - 11FEB2026
270312	57.217 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel (manual)	Form and Instruction	Modified	Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel_29SEP2025
270312	57.217 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel (manual)	Form and Instruction	Modified	Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel
270312	57.217 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel (manual)	Form and Instruction	Modified
270310	57.216 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents (.csv)	Form and Instruction	Modified	57.216 - Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents - 11FEB2026
270310	57.216 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents (.csv)	Form and Instruction	Modified	Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents Form 57.216_rev 29SEP2025
270310	57.216 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents (.csv)	Form and Instruction	Modified	Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents
270310	57.216 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents (.csv)	Form and Instruction	Modified
270309	57.216 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents (manual)	Form and Instruction	Modified	57.216 - Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents - 11FEB2026
270309	57.216 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents (manual)	Form and Instruction	Modified	Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents Form 57.216_rev 29SEP2025
270309	57.216 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents (manual)	Form and Instruction	Modified	Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents
270309	57.216 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents (manual)	Form and Instruction	Modified
269868	57.102 - Hospital Respiratory Data Fomr (Daily - API)	Form and Instruction	Unchanged	Hospital Respiratory Data Daily Reporting Form 14AUG2024
269868	57.102 - Hospital Respiratory Data Fomr (Daily - API)	Form and Instruction	Unchanged
269867	57.102 Hospital Respiratory Data Form (Daily - .csv import)	Form and Instruction	Unchanged	Hospital Respiratory Data Daily Reporting Form 14AUG2024
269867	57.102 Hospital Respiratory Data Form (Daily - .csv import)	Form and Instruction	Unchanged
269866	57.102 - Hospital Respiratory Data Form (Daily - user entry)	Form and Instruction	Unchanged	Hospital Respiratory Data Daily Reporting Form 14AUG2024
269866	57.102 - Hospital Respiratory Data Form (Daily - user entry)	Form and Instruction	Unchanged
269865	57.101 Hospital Respiratory Data Form (Weekly - API)	Form and Instruction	Unchanged	Hospital Respiratory Data Weekly Reporting Form
269865	57.101 Hospital Respiratory Data Form (Weekly - API)	Form and Instruction	Unchanged
269864	57.101 Hospital Respiratory Data Form (Weekly - .csv import)	Form and Instruction	Unchanged	Hospital Respiratory Data Weekly Reporting Form
269864	57.101 Hospital Respiratory Data Form (Weekly - .csv import)	Form and Instruction	Unchanged
269863	57.101 Hospital Respiratory Data Form (Weekly - User Entry)	Form and Instruction	Unchanged	Hospital Respiratory Data Weekly Reporting Form
269863	57.101 Hospital Respiratory Data Form (Weekly - User Entry)	Form and Instruction	Unchanged
266012	57.155 Point of Care Testing Results - Manual	Form and Instruction	Modified	Point of Care Testing Results - 11FEB2026
266012	57.155 Point of Care Testing Results - Manual	Form and Instruction	Modified	Point of Care Testing Results
266012	57.155 Point of Care Testing Results - Manual	Form and Instruction	Modified
249436	57.509 Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities_Manual	Form and Instruction	Modified	57.509 - Weekly COVID-19 Vaccination Cumulative Summary for Dialysis Patients - 11FEB2026
249436	57.509 Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities_Manual	Form and Instruction	Modified	Weekly COVID-19 Vaccination Cumulative Summary for Dialysis Patients_Manual
249436	57.509 Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities_Manual	Form and Instruction	Modified
249435	57.218 Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities (manual)	Form and Instruction	Modified	57.218 - Weekly Respiratory Pathogen and Vaccination Summary for Residents of LTCF - 11FEB2026
249435	57.218 Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities (manual)	Form and Instruction	Modified	57.218 Weekly Respiratory Pathogen and Vaccination Summary for Residents of LTCF_25SEP2025
249435	57.218 Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities (manual)	Form and Instruction	Modified	Weekly Respiratory Pathogen and Vaccination Summary for Residents of LTCF (manual)
249435	57.218 Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities (manual)	Form and Instruction	Modified	Weekly Respiratory Pathogen and Vaccination Summary for Residents of Long-Term Care Facilities (manual)
249435	57.218 Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities (manual)	Form and Instruction	Modified
249434	Weekly Healthcare Personnel COVID-19 Vaccination Cumulative Summary (manual)	Form and Instruction	Unchanged	57.219 Healthcare Personnel COVID-19 Vaccination Cumulative Summary
249434	Weekly Healthcare Personnel COVID-19 Vaccination Cumulative Summary (manual)	Form and Instruction	Unchanged	Healthcare Personnel COVID-19 Vaccination Cumulative Summary
249434	Weekly Healthcare Personnel COVID-19 Vaccination Cumulative Summary (manual)	Form and Instruction	Unchanged
243719	57.510 COVID–19 Module Dialysis Outpatient Facility_Manual	Form and Instruction	Unchanged	COVID–19 Module - Dialysis Outpatient Facility
243719	57.510 COVID–19 Module Dialysis Outpatient Facility_Manual	Form and Instruction	Unchanged
243698	57.140 NHSN and Secure Access Management Services (SAMS) enrollment	Form and Instruction	Modified	NHSN Registration Form
243698	57.140 NHSN and Secure Access Management Services (SAMS) enrollment	Form and Instruction	Modified

ICR Details

OMB Control No: 0920-1317	ICR Reference No: 202602-0920-005
Status: Received in OIRA	Previous ICR Reference No: 202509-0920-004
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: [NCEZID] National Healthcare Safety Network (NHSN) Respiratory Data
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 02/11/2026

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	01/31/2028
Responses	3,323,021	3,323,021
Time Burden (Hours)	1,718,235	1,558,384
Cost Burden (Dollars)	0	0

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Abstract: The goal of this information collection is to 1) capture the daily, aggregate impact of COVID-19 on healthcare facilities, and 2) monitor medical capacity to respond at local, state, and national levels. This information will be used to inform the overall real-time COVID-19 response efforts and possible resource allocation, and enable state and local health departments to gain immediate access to the COVID-19 data for healthcare facilities within their jurisdiction. This Revision is submitted to, make minor changes to wording used on several forms, make adjustments to the burden estimate (increase), and to modify the title of the data collection to: National Healthcare Safety Network (NHSN) Respiratory Data.

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Authorizing Statute(s): US Code: 42 USC 242b, k, m Name of Law: U.S. Public Health Service Act (PHSA)
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 25300	06/16/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 59833	12/22/2025
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 21

table that charts list of burden

IC Title	Form No.	Form Name
57.101 Hospital Respiratory Data Form (Weekly - .csv import)	0920-1317	Hospital Respiratory Data Weekly Reporting Form
57.101 Hospital Respiratory Data Form (Weekly - API)	0920-1317	Hospital Respiratory Data Weekly Reporting Form
57.101 Hospital Respiratory Data Form (Weekly - User Entry)	0920-1317	Hospital Respiratory Data Weekly Reporting Form
57.102 - Hospital Respiratory Data Fomr (Daily - API)	57.102	Hospital Respiratory Data Daily Reporting Form 14AUG2024
57.102 - Hospital Respiratory Data Form (Daily - user entry)	57.102	Hospital Respiratory Data Daily Reporting Form 14AUG2024
57.102 Hospital Respiratory Data Form (Daily - .csv import)	57.102	Hospital Respiratory Data Daily Reporting Form 14AUG2024
57.140 NHSN and Secure Access Management Services (SAMS) enrollment	57.140	NHSN Registration Form
57.155 Point of Care Testing Results - CSV	57.155, 0920-1317	Point of Care Testing Results ,   Point of Care Testing Results - 11FEB2026
57.155 Point of Care Testing Results - Manual	57.155, 57.155	Point of Care Testing Results ,   Point of Care Testing Results - 11FEB2026
57.216 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents (.csv)	57.216, 57.216, 57.216	Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents ,   Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents Form 57.216_rev 29SEP2025 ,   57.216 - Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents - 11FEB2026
57.216 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents (manual)	57.216, 57.216, 57.216	Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents ,   Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents Form 57.216_rev 29SEP2025 ,   57.216 - Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents - 11FEB2026
57.217 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel (.csv)	57.217, 57.217, 57.217	Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel ,   Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel 29SEP2025 ,   57.217 - Optional Person-Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel - 11FEB2026
57.217 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel (manual)	57.217, 57.217, 57.217	Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel ,   Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel_29SEP2025 ,   57.217 - Optional Person-Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel - 11FEB2026
57.218 Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities (.csv)	57.218, 57.218, 57.218, 57.218	Weekly Respiratory Pathogen and Vaccination Summary for Residents of Long-Term Care Facilities ,   Weekly Respiratory Pathogen and Vaccination Summary for Residents of LTCF (.csv) ,   57.218 Weekly Respiratory Pathogen and Vaccination Summary for Residents of LTCF_25SEP2025 ,   57.218 - Weekly Respiratory Pathogen and Vaccination Summary for Residents of LTCF - 11FEB2026
57.218 Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities (manual)	57.218, Form 57.218, 57.218, 57.218	Weekly Respiratory Pathogen and Vaccination Summary for Residents of Long-Term Care Facilities (manual) ,   Weekly Respiratory Pathogen and Vaccination Summary for Residents of LTCF (manual) ,   57.218 Weekly Respiratory Pathogen and Vaccination Summary for Residents of LTCF_25SEP2025 ,   57.218 - Weekly Respiratory Pathogen and Vaccination Summary for Residents of LTCF - 11FEB2026
57.509 Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities-.CSV	57.509, 57.509	57.509 Weekly COVID-19 Vaccination Cumulative Summary for Dialysis Patients_CSV ,   57.509 - Weekly COVID-19 Vaccination Cumulative Summary for Dialysis Patients - 11FEB2026
57.509 Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities_Manual	57.509, 57.509	Weekly COVID-19 Vaccination Cumulative Summary for Dialysis Patients_Manual ,   57.509 - Weekly COVID-19 Vaccination Cumulative Summary for Dialysis Patients - 11FEB2026
57.510 COVID–19 Module Dialysis Outpatient Facility-CSV	57.510	57.510 COVID–19 Module Dialysis Outpatient Facility-.csv
57.510 COVID–19 Module Dialysis Outpatient Facility_Manual	57.510	COVID–19 Module - Dialysis Outpatient Facility
Weekly Healthcare Personnel COVID-19 Vaccination Cumulative Summary (.csv)	57.219, 57.219	Healthcare Personnel COVID-19 Vaccination Cumulative Summary ,   57.219 Healthcare Personnel COVID-19 Vaccination Cumulative Summary_25SEP2025
Weekly Healthcare Personnel COVID-19 Vaccination Cumulative Summary (manual)	57.219, 57.219	Healthcare Personnel COVID-19 Vaccination Cumulative Summary ,   57.219 Healthcare Personnel COVID-19 Vaccination Cumulative Summary

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ICR Summary of Burden

table that charts list of burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	3,323,021	3,323,021	0	0	0	0
Annual Time Burden (Hours)	1,718,235	1,558,384	0	159,851	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Revision for 0920-1317 is submitted to, make minor changes to wording used on several forms, and results in an increase to the previously approved burden estimate.

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Annual Cost to Federal Government: $57,681,725

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Yes

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 02/11/2026

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