2024-24301. Agency Forms Undergoing Paperwork Reduction Act Review

Estimated Annualized Burden Hours

	Form No.	Form	Number of respondents	Number of responses per respondent	Average burden per response (in minutes)
1	57.101	Hospital Respiratory Data Form (Weekly) (user entry)	1,148	52	202
	57.101	Hospital Respiratory Data Form (Weekly) (.csv import)	3,444	52	29
	57.101	Hospital Respiratory Data Form (Weekly) (API)	1,786	52	15
2	57.102	Hospital Respiratory Data Form (Daily) (user entry)	492	365	58
	57.102	Hospital Respiratory Data Form (Daily) (.csv import)	1,476	365	29
	57.102	Hospital Respiratory Data Form (Daily) (API)	765	365	15
3	57.140	National Healthcare Safety Network (NHSN) Registration Form	11,500	1	5
4	57.155	Point of Care Testing Results-Manual	3,135	150	12
	57.155	Point of Care Testing Results-CSV	3,135	150	12
5	57.216	Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents (manual)	1,669	52	62
	57.216	Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents (.csv)	167	52	62
6	57.217	Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel (manual)	96	52	62
	57.217	Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel (.csv)	106	52	62
7	57.218	Weekly Respiratory Pathogen and Vaccination Summary for Residents of Long-Term Care Facilities (manual)	10,500	52	25
	57.218	Weekly Respiratory Pathogen and Vaccination Summary for Residents of Long-Term Care Facilities (csv)	6,000	52	20
8	57.219	Healthcare Personnel COVID-19 Vaccination Cumulative Summary (manual)	11,360	12	45
	57.219	Healthcare Personnel COVID-19 Vaccination Cumulative Summary (.csv)	4,107	12	40
9	57.220	Weekly Person Level Respiratory Pathogen and Vaccination for Residents of Long-Term Care Facilities-Long-term Care Facility Component (Manual Entry)	1,600	52	60
	57.220	Weekly Person Level Respiratory Pathogen and Vaccination for Residents of Long-Term Care Facilities-Long-term Care Facility Component (CSV Entry)	1,600	52	40
10	57.221	Healthcare Personnel COVID-19 Person Level Vaccination-Long-Term Care Component (Manual)	73	52	60
	57.221	Healthcare Personnel COVID-19 Person Level Vaccination-Long-Term Care Component (CSV)	73	52	40
( print page 84148)
	57.221	Healthcare Personnel COVID-19 Person Level Vaccination-Healthcare Personnel Safety Component (Manual)	73	12	60
	57.221	Healthcare Personnel COVID-19 Person Level Vaccination-Healthcare Personnel Safety Component (CSV)	73	12	40
11	57.509	Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities-Manual	107	12	45
	57.509	Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities-.CSV	2,802	12	40
12	57.510	COVID-19 Module Dialysis Outpatient Facility-manual	500	12	20
	57.510	COVID-19 Module Dialysis Outpatient Facility-.csv	500	12	10