OMB
.report
Search
COVID-19 Supplies Form - Microbiologist
National Healthcare Safety Network (NHSN) Patient Impact Module for Coronavirus (COVID-19) Surveillance in Healthcare Facilities
OMB: 0920-1290
IC ID: 241301
OMB.report
HHS/CDC
OMB 0920-1290
ICR 202008-0920-012
IC 241301
( )
Documents and Forms
Document Name
Document Type
Form 0920-1290
COVID-19 Supplies Form - Microbiologist
Form and Instruction
0920-1290 COVID-19 Supplies Form
Att8_NHSN COVID-19 Supplies Form .docx
Form and Instruction
0920-1290 COVID-19 Module Hospital Supply Pathway 01JUL2020
57.132_v2cCOVID-19_SUP 06122020 FINAL.docx
Form and Instruction
TOI_57.132_v2bCOVI-19 SUP_06122020 Final .docx
Instructions - Hospital Supply Pathway
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
COVID-19 Supplies Form - Microbiologist
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
0920-1290
COVID-19 Supplies Form
Att8_NHSN COVID-19 Supplies Form .docx
NA
Yes
Yes
Fillable Fileable
Form and Instruction
0920-1290
COVID-19 Module Hospital Supply Pathway 01JUL2020
57.132_v2cCOVID-19_SUP 06122020 FINAL.docx
NA
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
2,079
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
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
374,220
0
0
0
0
374,220
Annual IC Time Burden (Hours)
187,110
0
0
0
0
187,110
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Instructions - Hospital Supply Pathway
TOI_57.132_v2bCOVI-19 SUP_06122020 Final .docx
07/01/2020
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.