OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

57.509 Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities_Manual

IC 249436 under ICR 202602-0920-005 · OMB 0920-1317.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

57.509 Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities_Manual 0920-1317
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 57.509 Weekly COVID-19 Vaccination Cumulative Summary for Dialysis Patients_Manual COVIDVax.Dialysis.FORM_September2021_ARB.EK.docx NA Yes Yes Fillable Fileable
Form and Instruction 57.509 57.509 - Weekly COVID-19 Vaccination Cumulative Summary for Dialysis Patients - 11FEB2026 57.509 Weekly Patient COVID-19 Vaccination Summary.Dialysis Facilities.September 2025.Clean.docx N/A Yes Yes Fillable Fileable

Health Public Health Monitoring

 

107 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,284 0 0 0 0 1,284
Annual IC Time Burden (Hours) 963 0 0 0 0 963
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.
Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].