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57.218 Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities (manual)
[NCEZID] National Healthcare Safety Network (NHSN) Respiratory Data
OMB: 0920-1317
IC ID: 249435
OMB.report
HHS/CDC
OMB 0920-1317
ICR 202602-0920-005
IC 249435
( )
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
57.218 Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities (manual)
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Mandatory
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
Form 57.218
Weekly Respiratory Pathogen and Vaccination Summary for Residents of Long-Term Care Facilities (manual)
57.218 Weekly Respiratory Pathogen and Vaccination Summary for Residents of Long-Term Care Facilities.docx
N/A
Yes
Yes
Fillable Fileable
Form and Instruction
57.218
Weekly Respiratory Pathogen and Vaccination Summary for Residents of LTCF (manual)
57.218 Weekly Respiratory Pathogen and Vaccination Summary for Residents of LTCF 08JAN2025.docx
N/A
Yes
Yes
Fillable Fileable
Form and Instruction
57.218
57.218 Weekly Respiratory Pathogen and Vaccination Summary for Residents of LTCF_25SEP2025
57.218_RPV Res_LTC_Oct 2025_Clean.docx
N/A
Yes
Yes
Fillable Fileable
Form and Instruction
57.218
57.218 - Weekly Respiratory Pathogen and Vaccination Summary for Residents of LTCF - 11FEB2026
57.218 Weekly Respiratory Pathogen and Vaccination Summary for Residents of Long-Term Care Facilities - Clean.docx
N/A
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
11,207
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits, Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
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
582,764
0
0
0
0
582,764
Annual IC Time Burden (Hours)
388,509
0
145,691
0
0
242,818
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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