OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

[NCEZID] National Healthcare Safety Network (NHSN) Respiratory Data

OMB 0920-1317 · HHS/CDC.

OMB 0920-1317

The goal of this information collection is to 1) capture the daily, aggregate impact of COVID-19 on healthcare facilities, and 2) monitor medical capacity to respond at local, state, and national levels. This information will be used to inform the overall real-time COVID-19 response efforts and possible resource allocation, and enable state and local health departments to gain immediate access to the COVID-19 data for healthcare facilities within their jurisdiction. This Change Request is submitted for 0920-01317 to update forms, following revised ACIP vaccine recommendations for COVID-19. There is a net decrease in burden hours associated with this Change Request.

The latest form for [NCEZID] National Healthcare Safety Network (NHSN) Respiratory Data expires 2028-01-31 and is listed under ICR 202509-0920-004.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form 57.510 57.510 COVID–19 Module Dialysis Outpatient Facility-.csvForm and Instruction
Form 57.509 57.509 - Weekly COVID-19 Vaccination Cumulative Summary for Dialysis Patients - 11FEB2026Form and Instruction
Form 57.509 57.509 Weekly COVID-19 Vaccination Cumulative Summary for Dialysis Patients_CSVForm and Instruction
Form 0920-1317 Point of Care Testing Results - 11FEB2026Form and Instruction
Form 57.155 Point of Care Testing ResultsForm and Instruction
Form 57.219 57.219 Healthcare Personnel COVID-19 Vaccination Cumulative Summary_25SEP2025Form and Instruction
Form 57.219 Healthcare Personnel COVID-19 Vaccination Cumulative SummaryForm and Instruction
Form 57.218 57.218 - Weekly Respiratory Pathogen and Vaccination Summary for Residents of LTCF - 11FEB2026Form
Form 57.218 57.218 Weekly Respiratory Pathogen and Vaccination Summary for Residents of LTCF_25SEP2025Form and Instruction
Form 57.218 Weekly Respiratory Pathogen and Vaccination Summary for Residents of LTCF (.csv)Form and Instruction
Form 57.218 Weekly Respiratory Pathogen and Vaccination Summary for Residents of Long-Term Care FacilitiesForm and Instruction
Form 57.217 57.217 - Optional Person-Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel - 11FEB2026Form and Instruction
Form 57.217 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel 29SEP2025Form and Instruction
Form 57.217 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel (document unavailable)Form and Instruction
Form 57.217 57.217 - Optional Person-Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel - 11FEB2026Form and Instruction
Form 57.217 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel_29SEP2025Form and Instruction
Form 57.217 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare PersonnelForm and Instruction
Form 57.216 57.216 - Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents - 11FEB2026Form and Instruction
Form 57.216 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents Form 57.216_rev 29SEP2025Form and Instruction
Form 57.216 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care ResidentsForm and Instruction
Form 57.216 57.216 - Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents - 11FEB2026Form and Instruction
Form 57.216 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents Form 57.216_rev 29SEP2025Form and Instruction
Form 57.216 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care ResidentsForm and Instruction
Form 57.102 Hospital Respiratory Data Daily Reporting Form 14AUG2024Form and Instruction
Form 57.102 Hospital Respiratory Data Daily Reporting Form 14AUG2024Form and Instruction
Form 57.102 Hospital Respiratory Data Daily Reporting Form 14AUG2024Form and Instruction
Form 0920-1317 Hospital Respiratory Data Weekly Reporting FormForm and Instruction
Form 0920-1317 Hospital Respiratory Data Weekly Reporting FormForm and Instruction
Form 0920-1317 Hospital Respiratory Data Weekly Reporting FormForm and Instruction
Form 57.155 Point of Care Testing Results - 11FEB2026Form and Instruction
Form 57.155 Point of Care Testing ResultsForm and Instruction
Form 57.509 57.509 - Weekly COVID-19 Vaccination Cumulative Summary for Dialysis Patients - 11FEB2026Form and Instruction
Form 57.509 Weekly COVID-19 Vaccination Cumulative Summary for Dialysis Patients_ManualForm and Instruction
Form 57.218 57.218 - Weekly Respiratory Pathogen and Vaccination Summary for Residents of LTCF - 11FEB2026Form and Instruction
Form 57.218 57.218 Weekly Respiratory Pathogen and Vaccination Summary for Residents of LTCF_25SEP2025Form and Instruction
Form 57.218 Weekly Respiratory Pathogen and Vaccination Summary for Residents of LTCF (manual)Form and Instruction
Form Form 57.218 Weekly Respiratory Pathogen and Vaccination Summary for Residents of Long-Term Care Facilities (manual)Form and Instruction
Form 57.219 57.219 Healthcare Personnel COVID-19 Vaccination Cumulative SummaryForm and Instruction
Form 57.219 Healthcare Personnel COVID-19 Vaccination Cumulative SummaryForm and Instruction
Form 57.510 COVID–19 Module - Dialysis Outpatient FacilityForm and Instruction
Form 57.140 NHSN Registration FormForm and Instruction
SSB 0920-1317 NHSN Respiratory Data.docxSupporting Statement B
SSA 0920-1317 NHSN Respiratory Data Package.docxSupporting Statement A
G3. NHSN2-Cloud_PIA_Signed_2023-12-05_eRAP.pdfSupplementary Document
G2. NHSN_PIA_Signed_2023-01-19.pdfSupplementary Document
G1. Privacy Impact Assessment.pdfSupplementary Document
E3. Human Subjects Determination.pdfSupplementary Document
D2. Explanation for Program Changes or Adjustments 2025-0920-1317.docxSupplementary Document
D1. Explanation for Program Changes or Adjustments.docx (document unavailable)Supplementary Document
B1. Published 60-day FRN.pdfSupplementary Document
B5. Response to Commment_2.pdfPublic Comments
B4. Comment 2_Attachment_GNYHA.pdfPublic Comments
B3. Response to Commment_1.pdfPublic Comments
B2. Comment_1_Attachment_AHCA Comments on CDC PRA 60 Day_25_0023_Final.pdfPublic Comments
Change Memo 0920-1317 September 2025 FINAL_30SEP2025.docxJustification for No Material/Nonsubstantive Change
Change Request Memo - EO14168.docxJustification for No Material/Nonsubstantive Change
Change Memo 0920-1317 December 2024.docxJustification for No Material/Nonsubstantive Change
D. Explanation for Program Changes or Adjustments.docxSupplementary Document
G2. Privacy Impact Assessment.pdfSupplementary Document
G1. Privacy Impact Assessment.pdfSupplementary Document
G. Privacy Impact Assessment.pdfSupplementary Document
E3. Human Subjects Determination.pdfSupplementary Document
B. FRN-60 day.pdfSupplementary Document
Change Memo 0920-1317 August 2024_FINAL_v2.docxJustification for No Material/Nonsubstantive Change
Change Memo 0920-1317.docxJustification for No Material/Nonsubstantive Change
Change Request Memo NHSN COVID-19 0920-1317_26APR2024 v2.docxJustification for No Material/Nonsubstantive Change
Change Memo for CDC NHSN COVID-19 OMB Package 0920-1317.docxJustification for No Material/Nonsubstantive Change
Resident Impact and Facility Capacity- csv temp..csvSupplementary Document
TOI-Facility Importing COVID-19 and Respiratory Infections using a .csv file_RIFC.docxSupplementary Document
Change Memo for NHSN September 2023_0920_1317.docxJustification for No Material/Nonsubstantive Change
Crosswalk_57.218.docxSupplementary Document
Crosswalk_57.144.docxSupplementary Document
Crosswalk-COVID-19 Hospital Data.docxSupplementary Document
Crosswalk 11.4 updated COVID JUNE_final.docxSupplementary Document
Change Memo for NHSN May 2023_0920_1317_final.docxJustification for No Material/Nonsubstantive Change
CDC Response to APIC Dec29 letter sk lw.docxSupplementary Document
5. NHSN - Report of End of Human Research Review 0.1253.docxSupplementary Document
6. IRB Protocol Closure.pdfSupplementary Document
3. Privacy Act Checklist 2022.docxSupplementary Document
1c. 42 USC 242m.PDFSupplementary Document
1b. 42 USC 242k.PDFSupplementary Document
1a. 42 USC 242b.PDFSupplementary Document
57.510 COVID–19 Module Dialysis Outpatient Facility-CSV Form and Instruction
57.510 COVID–19 Module Dialysis Outpatient Facility-CSV Form and Instruction
57.509 Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities-.CSV Form and Instruction
57.509 Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities-.CSV Form and Instruction
57.509 Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities-.CSV Form and Instruction
57.155 Point of Care Testing Results - CSV Form and Instruction
57.155 Point of Care Testing Results - CSV Form and Instruction
57.155 Point of Care Testing Results - CSV Form and Instruction
Weekly Healthcare Personnel COVID-19 Vaccination Cumulative Summary (.csv) Form and Instruction
Weekly Healthcare Personnel COVID-19 Vaccination Cumulative Summary (.csv) Form and Instruction
Weekly Healthcare Personnel COVID-19 Vaccination Cumulative Summary (.csv) Form and Instruction
57.218 Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities (.csv) Form
57.218 Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities (.csv) Form and Instruction
57.218 Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities (.csv) Form and Instruction
57.218 Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities (.csv) Form and Instruction
57.218 Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities (.csv) Form and Instruction
57.217 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel (.csv) Form and Instruction
57.217 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel (.csv) Form and Instruction
57.217 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel (.csv) Form and Instruction
57.217 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel (.csv) Form and Instruction
57.217 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel (manual) Form and Instruction
57.217 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel (manual) Form and Instruction
57.217 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel (manual) Form and Instruction
57.217 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel (manual) Form and Instruction
57.216 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents (.csv) Form and Instruction
57.216 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents (.csv) Form and Instruction
57.216 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents (.csv) Form and Instruction
57.216 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents (.csv) Form and Instruction
57.216 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents (manual) Form and Instruction
57.216 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents (manual) Form and Instruction
57.216 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents (manual) Form and Instruction
57.216 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents (manual) Form and Instruction
57.102 - Hospital Respiratory Data Fomr (Daily - API) Form and Instruction
57.102 - Hospital Respiratory Data Fomr (Daily - API) Form and Instruction
57.102 Hospital Respiratory Data Form (Daily - .csv import) Form and Instruction
57.102 Hospital Respiratory Data Form (Daily - .csv import) Form and Instruction
57.102 - Hospital Respiratory Data Form (Daily - user entry) Form and Instruction
57.102 - Hospital Respiratory Data Form (Daily - user entry) Form and Instruction
57.101 Hospital Respiratory Data Form (Weekly - API) Form and Instruction
57.101 Hospital Respiratory Data Form (Weekly - API) Form and Instruction
57.101 Hospital Respiratory Data Form (Weekly - .csv import) Form and Instruction
57.101 Hospital Respiratory Data Form (Weekly - .csv import) Form and Instruction
57.101 Hospital Respiratory Data Form (Weekly - User Entry) Form and Instruction
57.101 Hospital Respiratory Data Form (Weekly - User Entry) Form and Instruction
57.155 Point of Care Testing Results - Manual Form and Instruction
57.155 Point of Care Testing Results - Manual Form and Instruction
57.155 Point of Care Testing Results - Manual Form and Instruction
57.509 Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities_Manual Form and Instruction
57.509 Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities_Manual Form and Instruction
57.509 Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities_Manual Form and Instruction
57.218 Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities (manual) Form and Instruction
57.218 Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities (manual) Form and Instruction
57.218 Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities (manual) Form and Instruction
57.218 Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities (manual) Form and Instruction
57.218 Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities (manual) Form and Instruction
Weekly Healthcare Personnel COVID-19 Vaccination Cumulative Summary (manual) Form and Instruction
Weekly Healthcare Personnel COVID-19 Vaccination Cumulative Summary (manual) Form and Instruction
Weekly Healthcare Personnel COVID-19 Vaccination Cumulative Summary (manual) Form and Instruction
57.510 COVID–19 Module Dialysis Outpatient Facility_Manual Form and Instruction
57.510 COVID–19 Module Dialysis Outpatient Facility_Manual Form and Instruction
57.140 NHSN and Secure Access Management Services (SAMS) enrollment Form and Instruction
57.140 NHSN and Secure Access Management Services (SAMS) enrollment Form and Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202602-0920-005 Revision of a currently approved collection 2026-02-11
202509-0920-004 No material or nonsubstantive change to a currently approved collection 2025-09-30
202502-0920-015 No material or nonsubstantive change to a currently approved collection 2025-03-28
202501-0920-003 No material or nonsubstantive change to a currently approved collection 2025-01-10 Approved without change
202410-0920-012 Revision of a currently approved collection 2024-10-30
202408-0920-011 No material or nonsubstantive change to a currently approved collection 2024-08-22 Approved without change
202407-0920-003 No material or nonsubstantive change to a currently approved collection 2024-08-06 Approved with change
202404-0920-010 No material or nonsubstantive change to a currently approved collection 2024-04-26 Approved without change
202403-0920-007 No material or nonsubstantive change to a currently approved collection 2024-03-14 Approved without change
202309-0920-001 No material or nonsubstantive change to a currently approved collection 2023-09-07 Approved with change
202305-0920-005 No material or nonsubstantive change to a currently approved collection 2023-05-18 Approved with change
202211-0920-014 Revision of a currently approved collection 2022-11-30 Approved with change
202207-0920-002 No material or nonsubstantive change to a currently approved collection 2022-07-18 Approved without change
202205-0920-010 No material or nonsubstantive change to a currently approved collection 2022-05-24 Approved with change
202109-0920-006 No material or nonsubstantive change to a currently approved collection 2021-09-22 Approved with change
202105-0920-014 No material or nonsubstantive change to a currently approved collection 2021-05-28 Approved with change
202102-0920-015 No material or nonsubstantive change to a currently approved collection 2021-02-26 Approved with change
202101-0920-017 No material or nonsubstantive change to a currently approved collection 2021-01-28 Approved with change
202009-0920-011 New collection (Request for a new OMB Control Number) 2020-09-23 Approved with change

OMB Details

57.140 NHSN and Secure Access Management Services (SAMS) enrollment

Federal Enterprise Architecture: Health - Public Health Monitoring

Information collection instruments
FormNameElectronic accessType
Form 0920-1317NHSN Registration FormFillable FileableForm and instruction

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