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Information Collection

Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities

IC 249435 under ICR 202407-0920-003 · OMB 0920-1317.

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

View Information Collection (IC)

Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities 0920-1317
 
No Unchanged
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-1317 / CDC Form 57.218 Weekly COVID-19 Vaccination Cumulative Summary for Residents of Long-Term Care Facilities COVIDVax.LTC.Resident.FORM_September2021_FINAL.docx NA Yes Yes Fillable Fileable
Form and Instruction 0920-1317 Weekly Respiratory Pathogen and Vaccination Summary for Residents of LTCF-CDC 57.218_26APR2024 57.218 Weekly Resident COVID-19 Vaccination Cumulative Summary LTCF CSV_Clean.docx N/A Yes Yes Fillable Fileable

Health Public Health Monitoring

 

16,500 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Approved 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 858,000 0 0 0 0 858,000
Annual IC Time Burden (Hours) 357,500 0 0 0 0 357,500
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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