Information Collection

Weekly Healthcare Personnel COVID-19 Vaccination Cumulative Summary (manual)

IC 249434 under ICR 202602-0920-005 · OMB 0920-1317.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 57.219 Healthcare Personnel COVID-19 Vaccination Cumulative Summary Weekly Healthcare Personnel COVID-19 Vaccination Cumulative Summary (manual)	Form and Instruction
Form 57.219 57.219 Healthcare Personnel COVID-19 Vaccination Cumulative Summary Weekly Healthcare Personnel COVID-19 Vaccination Cumulative Summary (manual)	Form and Instruction
57.219 Healthcare Personnel COVID-19 Vaccination Cumulative Sum 57.219 Healthcare Personnel COVID-19 Vaccination Cumulative Summary CSV_Clean.docx	Form and Instruction
57.219 57.219 Healthcare Personnel COVID-19 Vaccination Cumulat 57.219_HCP COVID Vacc_LTC_Oct 2025_Clean.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

0920-1317

Is this a Common Form? No

IC Status: Unchanged

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	57.219				Yes	Yes	Fillable Fileable
Form and Instruction	57.219			NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 13,328

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	159,936	159,936
Annual IC Time Burden (Hours)	119,952	119,952
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.

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