OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Weekly Healthcare Personnel Influenza Vaccination Cumulative Summary for Non-Long-Term Care Facilities (CSV)

IC 272101 under ICR 202603-0920-006 · OMB 0920-0666.

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

View Information Collection (IC)

Weekly Healthcare Personnel Influenza Vaccination Cumulative Summary for Non-Long-Term Care Facilities (CSV) 0920-0666
 
No Removed
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 57.211 CSV Submission 57.211 CSV Submission.docx NA Yes Yes Fillable Fileable

Health Health Care Services

 

3,080 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 0 0 -36,960 0 0 36,960
Annual IC Time Burden (Hours) 0 0 -12,320 0 0 12,320
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Form Information only 57.211 Healthcare Personnel Influenza Vaccination Cumulative Summary for Non-LTCF.docx 11/04/2024
            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].