Emerging Infections Program Tracking of SARS-CoV-2 Infections among Healthcare Personnel

OMB 0920-1296

The goal of this information collection is to inform guidance for healthcare facilities to protect the healthcare workforce from the effects of COVID-19, the disease caused by the novel coronavirus SARS-CoV-2. The healthcare workforce is a critical asset during this pandemic. Protecting healthcare personnel (HCP) is an essential component of protecting patients.The data collected from this project will be used to inform guidance for healthcare facilities to protect HCP.

The latest form for Emerging Infections Program Tracking of SARS-CoV-2 Infections among Healthcare Personnel expires 2020-10-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form 0920-1296 Occupational Health Nurses at Healthcare Facilities -Assessment of Healthcare Personnel Exposed to or Infected with SARS-CoV-2: Denominator Form Form and Instruction
Form 0920-20MZ EIP or State Health Dept Employee Form and Instruction
Form 0920-20MZ Occupational Health Nurses at Healthcare Facilities (no form) Form
Form 0920-20MZ Assessment of Healthcare Personnel Exposed to or Infected with SARS-CoV-2 Form and Instruction
Att 1_EIP SARS-CoV-2 Infections among HCP Protocol 17SEP2020.docx Supplementary Document
Non-sub change request template_EIP COVID HCP Project_09_18_2020.docx Justification for No Material/Nonsubstantive Change
Non-sub change request template_EIP COVID HCP Project_08_19_2020.docx Justification for No Material/Nonsubstantive Change
HCP Case Tracking Protocol_8_17_2020_changes in number of contact attempts.docx Supplementary Document
Change Memo 0920-1296_v2.docx Justification for No Material/Nonsubstantive Change
Attachment 4_Protocol_7_17_2020_CLEAN.docx Supplementary Document
Emergency Review Request Memo - EIP Tracking of SARS-CoV-2 Infections among HCP_signed.pdf Supplementary Document
Att5_Research Determination Form.pdf Supplementary Document
Attachment3_Protocol omb_20200422.docx Supplementary Document
Att1_Authorizing Legislation.docx Supplementary Document
SSB_Tracking of HCP with COVID-19 omb_20200422.docx Supporting Statement B
SSA_Tracking of HCP with COVID-19 omb_20200422.docx Supporting Statement A
Occupational Health Nurses at Healthcare Facilities -Assessment of Healthcare Personnel Exposed to or Infected with SARS-CoV-2: Denominator Form Form and Instruction
EIP or State Health Dept Employee Form and Instruction
Occupational Health Nurses at Healthcare Facilities (no form) Form
Assessment of Healthcare Personnel Exposed to or Infected with SARS-CoV-2 Form and Instruction

All Historical Document Collections

202009-0920-021 Approved with change	No material or nonsubstantive change to a currently approved collection	2020-10-06
202008-0920-008 Approved with change	No material or nonsubstantive change to a currently approved collection	2020-08-25
202007-0920-015 Approved with change	No material or nonsubstantive change to a currently approved collection	2020-07-24
202004-0920-012 Approved with change	New collection (Request for a new OMB Control Number)	2020-04-28

OMB Details

Assessment of Healthcare Personnel Exposed to or Infected with SARS-CoV-2

Federal Enterprise Architecture: Health - Public Health Monitoring

Form 0920-20MZ

Assessment of Healthcare Personnel

Fillable Fileable

Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.