Information Collection

57.218 Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities (manual)

IC 249435 under ICR 202602-0920-005 · OMB 0920-1317.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Form 57.218 Weekly Respiratory Pathogen and Vaccination Summary for Residents of Long-Term Care Facilities (manual) 57.218 Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities (manual)	Form and Instruction
Form 57.218 Weekly Respiratory Pathogen and Vaccination Summary for Residents of LTCF (manual) 57.218 Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities (manual)	Form and Instruction
Form 57.218 57.218 Weekly Respiratory Pathogen and Vaccination Summary for Residents of LTCF_25SEP2025 57.218 Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities (manual)	Form and Instruction
Form 57.218 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)	Form and Instruction
Form 57.218 Weekly Respiratory Pathogen and Vaccination Summary for 57.218 Weekly Respiratory Pathogen and Vaccination Summary for Residents of Long-Term Care Facilities.docx	Form and Instruction
57.218 Weekly Respiratory Pathogen and Vaccination Summary for 57.218 Weekly Respiratory Pathogen and Vaccination Summary for Residents of LTCF 08JAN2025.docx	Form and Instruction
57.218 57.218 Weekly Respiratory Pathogen and Vaccination Summa 57.218_RPV Res_LTC_Oct 2025_Clean.docx	Form and Instruction
57.218 57.218 - Weekly Respiratory Pathogen and Vaccination Sum 57.218 Weekly Respiratory Pathogen and Vaccination Summary for Residents of Long-Term Care Facilities - Clean.docx	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

57.218 Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities (manual)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Form 57.218	N/A	Yes	Yes	Fillable Fileable
Form and Instruction	57.218	N/A	Yes	Yes	Fillable Fileable
Form and Instruction	57.218	N/A	Yes	Yes	Fillable Fileable
Form and Instruction	57.218	N/A	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 11,207

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
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	582,764	0	582,764
Annual IC Time Burden (Hours)	388,509	145,691	242,818
Annual IC Cost Burden (Dollars)	0	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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