Information Collection Request

The National Healthcare Safety Network (NHSN)

ICR 200901-0920-009 · OMB 0920-0666 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form 57.75A Patient Safety Monthly Reporting Plan Form Modified Available
Form 57.75CC List of Blood Isolates Form Modified Available
Form 57.75Za Healthcare Personnel Safety Component Facility Survey Form Modified Available
Form 57.75Z Implementation of Engineering (safety devices) Controls for Sharps Injury Prevention Form Modified Repair queued
Form 57.75Y Healthcare Worker Vaccination History Form Modified Repair queued
Form 57.75X Healthcare Worker Demographic Data Form Modified Repair queued
Form 57.75W Healthcare Worker Post-Exposure Prophylaxis Form Modified Repair queued
Form 57.75V Exposure to Blood and Body Fluids Form Modified Repair queued
Form 57.75U Group Contact Information Form Modified Repair queued
Form 57.75TT Laboratory-identified MDRO Event Summary Form Form Modified Available
Form 57.75T Agreement to Participate and Consent Form Modified Repair queued
Form 57.75SS High Risk Inpatient Influenza Vaccination Denominator Data Form - Method B Form Modified Repair queued
Form 57.75S Patient Safety Component Annual Facility Survey Form Modified Available
Form 57.75RR High Risk Inpatient Influenza Vaccination Monthly Monitoring Form - Method B Form Modified Repair queued
Form 57.75R Facility Contact Information Form Modified Available
Form 57.75QQ High Risk Inpatient Influenza Vaccination Numerator Data Form - Method B Form Modified Available
Form 57.75Q Antimicrobial Use and Resistence (AUR) - Pharmacy Data Form Modified Repair queued
Form 57.75PP High Risk Inpatient Influenza Vaccination Monthly Monitoring Form - Method A Form Modified Repair queued
Form 57.75P Antimicrobial Use and Resistance (AUR) - Microbiology Laboratory Data Form Modified Available
Form 57.75OO NHSN Registration Form Form Modified Repair queued
Form 57.75O Denominators for Procedure Form Modified Repair queued
Form 57.75NN Laboratory Identified MDRO Event Form Modified Available
Form 57.75N Surgical Site Infection (SSI) Form Modified Available
Form 57.75MM MDRO Infection Event Form Modified Repair queued
Form 57.75M Denominators for Outpatient Dialysis Form Modified Repair queued
Form 57.75LL Multi-drug Resistant Organism (MDRO) Prevention Process and Outcome Measures Monthly Monitoring Form Form Modified Repair queued
Form 57.75L Denominators for Intensive Care Unit (ICU) Other Locations (not NICU or SCA) Form Modified Available
Form 57.75KK Laboratory Testing Form Modified Repair queued
Form 57.75K Denominators for Specialty Care Area (SCA) Form Modified Repair queued
Form 57.75JJ Central Line Insertion Practices Adherence Monitoring Form Form Modified Repair queued
Form 57.75J Denominators for Neonatal Intensive Care Unit (NICU) Form Modified Repair queued
Form 57.75II Post-Season Survey on Influenza Vaccination Programs for Healthcare Personnel Form Modified Available
Form 57.75HH Preseason Survey on Influenza Vaccination Program for Healthcare Personnel Form Modified Repair queued
Form 57.75H Urinary Tract Infection (UTI) Form Modified Repair queued
Form 57.75GG Healthcare Worker Influenza Antiviral Medication Administration Form Modified Available
Form 57.75G, 57.75Ga, 5 Pneumonia (includes Any Patient Pneumonia flow Diagram and Infant and Children Pneumonia Flow Diagram) Form and Instruction Modified Repair queued
Form 57.75FF Healthcare Worker Influenza Vaccination Form Modified Repair queued
Form 57.75E Dialysis Event Form Modified Repair queued
Form 57.75DD Manual Categorization of Positive Blood Cultures Form Modified Repair queued
Form 57.75D Primary Bloodstream Infection (BSI) Form Modified Available
Form 57.75BB Dialysis Survey Form Modified Available
Form 57.75B Healthcare Personnel Safety Reporting Plan Form Modified Repair queued
Form 57.75AA Healthcare Worker Survey Form Modified Available
0920-0666 83-C Supporting Statement_January 2009.doc Justification for No Material/Nonsubstantive Change Uploaded 2009-01-21 Available
IC Document Collections
IC IDCollectionTypeStatusForm
7134 Patient Safety Monthly Reporting Plan Form Modified
183583 List of Blood Isolates Form Modified
183582 Healthcare Personnel Safety Component Facility Survey Form Modified
183581 Implementation of Engineering (safety devices) Controls for Sharps Injury Prevention Form Modified
183580 Healthcare Worker Vaccination History Form Modified
183579 Healthcare Worker Demographic Data Form Modified
183578 Healthcare Worker Post-Exposure Prophylaxis Form Modified
183577 Exposure to Blood and Body Fluids Form Modified
183576 Group Contact Information Form Modified
183575 Laboratory-identified MDRO Event Summary Form Form Modified
183574 Agreement to Participate and Consent Form Modified
183573 High Risk Inpatient Influenza Vaccination Denominator Data Form - Method B Form Modified
183572 Patient Safety Component Annual Facility Survey Form Modified
183571 High Risk Inpatient Influenza Vaccination Monthly Monitoring Form - Method B Form Modified
183570 Facility Contact Information Form Modified
183569 High Risk Inpatient Influenza Vaccination Numerator Data Form - Method B Form Modified
183568 Antimicrobial Use and Resistence (AUR) - Pharmacy Data Form Modified
183567 High Risk Inpatient Influenza Vaccination Monthly Monitoring Form - Method A Form Modified
183566 Antimicrobial Use and Resistance (AUR) - Microbiology Laboratory Data Form Modified
183565 NHSN Registration Form Form Modified
183564 Denominators for Procedure Form Modified
183563 Laboratory Identified MDRO Event Form Modified
183562 Surgical Site Infection (SSI) Form Modified
183561 MDRO Infection Event Form Modified
183560 Denominators for Outpatient Dialysis Form Modified
183559 Multi-drug Resistant Organism (MDRO) Prevention Process and Outcome Measures Monthly Monitoring Form Form Modified
183558 Denominators for Intensive Care Unit (ICU) Other Locations (not NICU or SCA) Form Modified
183557 Laboratory Testing Form Modified
183556 Denominators for Specialty Care Area (SCA) Form Modified
183555 Central Line Insertion Practices Adherence Monitoring Form Form Modified
183554 Denominators for Neonatal Intensive Care Unit (NICU) Form Modified
183553 Post-Season Survey on Influenza Vaccination Programs for Healthcare Personnel Form Modified
183552 Preseason Survey on Influenza Vaccination Program for Healthcare Personnel Form Modified
183551 Urinary Tract Infection (UTI) Form Modified
183550 Healthcare Worker Influenza Antiviral Medication Administration Form Modified
183549 Pneumonia (includes Any Patient Pneumonia flow Diagram and Infant and Children Pneumonia Flow Diagram) Form and Instruction Modified
183548 Healthcare Worker Influenza Vaccination Form Modified
183547 Dialysis Event Form Modified
183546 Manual Categorization of Positive Blood Cultures Form Modified
183545 Primary Bloodstream Infection (BSI) Form Modified
183544 Dialysis Survey Form Modified
183543 Healthcare Personnel Safety Reporting Plan Form Modified
183542 Healthcare Worker Survey Form Modified
ICR Details
0920-0666 200901-0920-009
Historical Active 200801-0920-009
HHS/CDC
The National Healthcare Safety Network (NHSN)
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 02/18/2009
Retrieve Notice of Action (NOA) 01/30/2009
  Inventory as of this Action Requested Previously Approved
03/31/2011 03/31/2011 03/31/2011
9,511,550 0 2,386,250
5,144,844 0 1,278,315
162,000 0 40,500

The NHSN is a knowledge system for accumulating, exchanging and integrating relevant information and resources among private and public stakeholders to support local and national efforts to protect patients and healthcare personnel by promoting healthcare safety. Specifically, the data will be used to determine the magnitude of various healthcare-associated adverse events and trends in the rates of these events among patients and healthcare personnel with similar risks or exposures.

US Code: 42 USC 241 Name of Law: Public Health Service Act
  
None

Not associated with rulemaking

  72 FR 41077 07/26/2007
72 FR 65578 11/21/2007
Yes

43
IC Title Form No. Form Name
MDRO Infection Event 57.75MM MDRO Infection Event
Surgical Site Infection (SSI) 57.75N Surgical Site Infection (SSI)
Laboratory Identified MDRO Event 57.75NN Laboratory Identified MDRO Event
Denominators for Procedure 57.75O Denominators for Procedure
NHSN Registration Form 57.75OO NHSN Registration Form
Antimicrobial Use and Resistance (AUR) - Microbiology Laboratory Data 57.75P Antimicrobial Use and Resistance (AUR) - Microbiology Laboratory Data
High Risk Inpatient Influenza Vaccination Monthly Monitoring Form - Method A 57.75PP High Risk Inpatient Influenza Vaccination Monthly Monitoring Form - Method A
Antimicrobial Use and Resistence (AUR) - Pharmacy Data 57.75Q Antimicrobia Use and Resistence (AUR) - Pharmacy Data
High Risk Inpatient Influenza Vaccination Numerator Data Form - Method B 57.75QQ High Risk Inpatient Influenza Vaccination Numerator Data Form - Method B
Facility Contact Information 57.75R Facility Contact Information
High Risk Inpatient Influenza Vaccination Monthly Monitoring Form - Method B 57.75RR High Risk Inpatient Influenza Vaccination Monthly Monitoring Form - Method B
Denominators for Neonatal Intensive Care Unit (NICU) 57.75J Demonination for Neonatal Intensive Care Unit (NICU)
Central Line Insertion Practices Adherence Monitoring Form 57.75JJ Central Line Insertion Practices Adherence Monitoring Form
Denominators for Specialty Care Area (SCA) 57.75K Denominators for Specialty Care Area (SCA)
Laboratory Testing 57.75KK Laboratory Testing
Denominators for Intensive Care Unit (ICU) Other Locations (not NICU or SCA) 57.75L Denominators for Intensive Care Unit (ICU) Other Locations (not NICU or SCA)
Multi-drug Resistant Organism (MDRO) Prevention Process and Outcome Measures Monthly Monitoring Form 57.75LL Multi-drug Resistant Organism (MDRO) Prevention Process and Outcome Measures Monthly Monitoring Form
Denominators for Outpatient Dialysis 57.75M Denominators for Outpatient Dialysis
Preseason Survey on Influenza Vaccination Program for Healthcare Personnel 57.75HH Preseason Survey on Influenza Vaccination Programs for Healthcare Personnel
Post-Season Survey on Influenza Vaccination Programs for Healthcare Personnel 57.75II Post-Season Survey on Influenza Vaccination Programs for Healthcare Personnel
Healthcare Personnel Safety Component Facility Survey 57.75Za Healthcare Personnel Safety Component Facility Survey
List of Blood Isolates 57.75CC List of Blood Isolates
Patient Safety Component Annual Facility Survey 57.75S Patient Safety Component Annual Facility Survey
High Risk Inpatient Influenza Vaccination Denominator Data Form - Method B 57.75SS High Risk Inpatient Influenza Vaccination Denominator Data Form - Method B
Agreement to Participate and Consent 57.75T Agreement to Participate and Consent
Laboratory-identified MDRO Event Summary Form 57.75TT Laboratory-identified MDRO Event Summary Form
Group Contact Information 57.75U Group Contact Information
Exposure to Blood and Body Fluids 57.75V Exposure to Blood and Body Fluids
Healthcare Worker Post-Exposure Prophylaxis 57.75W Healthcare Worker Post-Exposure Prophylaxis
Healthcare Worker Demographic Data 57.75X Healthcare Worker Demographic Data
Healthcare Worker Vaccination History 57.75Y Healthcare Worker Vaccination History
Implementation of Engineering (safety devices) Controls for Sharps Injury Prevention 57.75Z Implementation of Engineering (safety devices) Controls for Sharps Injury Prevention
Patient Safety Monthly Reporting Plan 57.75A A_PSPlan.ppt
Healthcare Worker Survey 57.75AA Healthcare Worker Survey
Healthcare Personnel Safety Reporting Plan 57.75B Healthcare Personnel Safety Reporting Plan
Dialysis Survey 57.75BB Dialysis Survey
Primary Bloodstream Infection (BSI) 57.75D Primary Bloodstream Infection (BSI)
Manual Categorization of Positive Blood Cultures 57.75DD Manual Categorization of Positive Cultures
Dialysis Event 57.75E Dialysis Event
Healthcare Worker Influenza Vaccination 57.75FF Healthcare Worker Influenza Vaccination
Pneumonia (includes Any Patient Pneumonia flow Diagram and Infant and Children Pneumonia Flow Diagram) 57.75G, 57.75Ga, 57.75Gb Pneumonia (includes Any Patient Pneumonia Flow Diagram and Infant and Children Pneumonia Flow Diagram)
Healthcare Worker Influenza Antiviral Medication Administration 57.75GG Healthcare Worker Influenza Antiviral Medication Administration
Urinary Tract Infection (UTI) 57.75H Urinary Tract Infection (UTI)

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 9,511,550 2,386,250 0 7,125,300 0 0
Annual Time Burden (Hours) 5,144,844 1,278,315 0 3,866,529 0 0
Annual Cost Burden (Dollars) 162,000 40,500 0 121,500 0 0
Yes
Miscellaneous Actions
No
Due to reporting requirements mandated by state legislatures, CDC requests approval to add 4,500 respondents, for a total of 6,000 respondents. The increase in respondents will result in an increase of 3,358,030 burden hours for this information collection, for a total of 4,636,345 burden hours.

$2,093,612
No
No
Uncollected
Uncollected
Uncollected
Uncollected
Maryam Daneshvar 4046394604

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
01/30/2009