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 can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form 57.510 57.510 COVID–19 Module Dialysis Outpatient Facility-.csv Form and Instruction
Form 57.509 57.509 - Weekly COVID-19 Vaccination Cumulative Summary for Dialysis Patients - 11FEB2026 Form and Instruction
Form 57.509 57.509 Weekly COVID-19 Vaccination Cumulative Summary for Dialysis Patients_CSV (document unavailable) Form and Instruction
Form 0920-1317 Point of Care Testing Results - 11FEB2026 (document unavailable) Form and Instruction
Form 57.155 Point of Care Testing Results Form and Instruction
Form 57.219 57.219 Healthcare Personnel COVID-19 Vaccination Cumulative Summary_25SEP2025 Form and Instruction
Form 57.219 Healthcare Personnel COVID-19 Vaccination Cumulative Summary Form and Instruction
Form 57.218 57.218 - Weekly Respiratory Pathogen and Vaccination Summary for Residents of LTCF - 11FEB2026 Form
Form 57.218 57.218 Weekly Respiratory Pathogen and Vaccination Summary for Residents of LTCF_25SEP2025 Form 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 Facilities Form and Instruction
Form 57.217 57.217 - Optional Person-Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel - 11FEB2026 Form and Instruction
Form 57.217 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel 29SEP2025 Form 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 - 11FEB2026 Form and Instruction
Form 57.217 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel_29SEP2025 Form and Instruction
Form 57.217 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel Form and Instruction
Form 57.216 57.216 - Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents - 11FEB2026 Form and Instruction
Form 57.216 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents Form 57.216_rev 29SEP2025 Form and Instruction
Form 57.216 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents Form and Instruction
Form 57.216 57.216 - Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents - 11FEB2026 Form and Instruction
Form 57.216 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents Form 57.216_rev 29SEP2025 Form and Instruction
Form 57.216 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents Form and Instruction
Form 57.102 Hospital Respiratory Data Daily Reporting Form 14AUG2024 Form and Instruction
Form 57.102 Hospital Respiratory Data Daily Reporting Form 14AUG2024 Form and Instruction
Form 57.102 Hospital Respiratory Data Daily Reporting Form 14AUG2024 Form and Instruction
Form 0920-1317 Hospital Respiratory Data Weekly Reporting Form Form and Instruction
Form 0920-1317 Hospital Respiratory Data Weekly Reporting Form Form and Instruction
Form 0920-1317 Hospital Respiratory Data Weekly Reporting Form Form and Instruction
Form 57.155 Point of Care Testing Results - 11FEB2026 Form and Instruction
Form 57.155 Point of Care Testing Results Form and Instruction
Form 57.509 57.509 - Weekly COVID-19 Vaccination Cumulative Summary for Dialysis Patients - 11FEB2026 Form and Instruction
Form 57.509 Weekly COVID-19 Vaccination Cumulative Summary for Dialysis Patients_Manual Form and Instruction
Form 57.218 57.218 - Weekly Respiratory Pathogen and Vaccination Summary for Residents of LTCF - 11FEB2026 Form and Instruction
Form 57.218 57.218 Weekly Respiratory Pathogen and Vaccination Summary for Residents of LTCF_25SEP2025 Form 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 Summary Form and Instruction
Form 57.219 Healthcare Personnel COVID-19 Vaccination Cumulative Summary Form and Instruction
Form 57.510 COVID–19 Module - Dialysis Outpatient Facility Form and Instruction
Form 57.140 NHSN Registration Form Form and Instruction
SSB 0920-1317 NHSN Respiratory Data.docx Supporting Statement B
SSA 0920-1317 NHSN Respiratory Data Package.docx (document unavailable) Supporting Statement A
G3. NHSN2-Cloud_PIA_Signed_2023-12-05_eRAP.pdf Supplementary Document
G2. NHSN_PIA_Signed_2023-01-19.pdf Supplementary Document
G1. Privacy Impact Assessment.pdf Supplementary Document
E3. Human Subjects Determination.pdf Supplementary Document
D2. Explanation for Program Changes or Adjustments 2025-0920-1317.docx Supplementary Document
D1. Explanation for Program Changes or Adjustments.docx (document unavailable) Supplementary Document
B1. Published 60-day FRN.pdf Supplementary Document
B5. Response to Commment_2.pdf (document unavailable) Public Comments
B4. Comment 2_Attachment_GNYHA.pdf Public Comments
B3. Response to Commment_1.pdf (document unavailable) Public Comments
B2. Comment_1_Attachment_AHCA Comments on CDC PRA 60 Day_25_0023_Final.pdf Public Comments
Change Memo 0920-1317 September 2025 FINAL_30SEP2025.docx (document unavailable) Justification for No Material/Nonsubstantive Change
Change Request Memo - EO14168.docx Justification for No Material/Nonsubstantive Change
Change Memo 0920-1317 December 2024.docx Justification for No Material/Nonsubstantive Change
D. Explanation for Program Changes or Adjustments.docx Supplementary Document
G2. Privacy Impact Assessment.pdf Supplementary Document
G1. Privacy Impact Assessment.pdf (document unavailable) Supplementary Document
G. Privacy Impact Assessment.pdf (document unavailable) Supplementary Document
E3. Human Subjects Determination.pdf Supplementary Document
B. FRN-60 day.pdf Supplementary Document
Change Memo 0920-1317 August 2024_FINAL_v2.docx Justification for No Material/Nonsubstantive Change
Change Memo 0920-1317.docx Justification for No Material/Nonsubstantive Change
Change Request Memo NHSN COVID-19 0920-1317_26APR2024 v2.docx Justification for No Material/Nonsubstantive Change
Change Memo for CDC NHSN COVID-19 OMB Package 0920-1317.docx Justification for No Material/Nonsubstantive Change
Resident Impact and Facility Capacity- csv temp..csv Supplementary Document
TOI-Facility Importing COVID-19 and Respiratory Infections using a .csv file_RIFC.docx (document unavailable) Supplementary Document
Change Memo for NHSN September 2023_0920_1317.docx Justification for No Material/Nonsubstantive Change
Crosswalk_57.218.docx Supplementary Document
Crosswalk_57.144.docx Supplementary Document
Crosswalk-COVID-19 Hospital Data.docx Supplementary Document
Crosswalk 11.4 updated COVID JUNE_final.docx Supplementary Document
Change Memo for NHSN May 2023_0920_1317_final.docx Justification for No Material/Nonsubstantive Change
CDC Response to APIC Dec29 letter sk lw.docx Supplementary Document
5. NHSN - Report of End of Human Research Review 0.1253.docx Supplementary Document
6. IRB Protocol Closure.pdf Supplementary Document
3. Privacy Act Checklist 2022.docx Supplementary Document
1c. 42 USC 242m.PDF Supplementary Document
1b. 42 USC 242k.PDF Supplementary Document
1a. 42 USC 242b.PDF (document unavailable) Supplementary 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

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

OMB Details

57.140 NHSN and Secure Access Management Services (SAMS) enrollment

Federal Enterprise Architecture: Health - Public Health Monitoring

Form 0920-1317

NHSN Registration Form

Fillable Fileable

Form and instruction

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