Att D-3

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Revision of Estimated Annual Burden Hours


Number of Respondents (Annual)
Responses per Respondent (Annual)
Burden per Response (Hours)
Total Annual Burden (Hours)
Change in Burden (Hours)
Form Number
Form Name
2009
2010
2009
2010
2009
2010
2009
2010

57.100
NHSN Registration Form
6,000
6,000
1
1
5/60
5/60
500
500
0
57.101
Facility Contact Information
6,000
6,000
1
1
10/60
10/60
1,000
1,000
0
57.102
N/A-Remove from ICR
6,000
0
1
0
15/60
0
1,500
0
(1,500)
57.103
Patient Safety Component--Annual Facility Survey
6,000
6,000
1
1
30/60
40/60
3,000
4,000
1,000
57.104
Patient Safety Component--Outpatient Dialysis Center Practices Survey
225
5,500
1
1
1
1
225
5,500
5,275
57.105
Group Contact Information
6,000
6,000
1
1
5/60
5/60
500
500
0
57.106
Patient Safety Monthly Reporting Plan
6,000
6,000
9
9
35/60
35/60
31,500
31,500
0
57.108
Primary Bloodstream Infection (BSI)
6,000
6,000
36
36
30/60
32/60
108,000
115,200
7,200
57.109
Dialysis Event
225
500
200
75
5/60
15/60
11,250
9,375
(1,875)
57.111
Pneumonia (PNEU)
6,000
6,000
72
72
30/60
32/60
216,000
230,400
14,400
57.112
N/A-Remove from ICR
-
-
-
-
-
-
-
-
-
57.113
N/A-Remove from ICR
-
-
-
-
-
-
-
-
-
57.114
Urinary Tract Infection (UTI)
6,000
6,000
27
27
30/60
32/60
81,000
86,400
5,400
57.116
Denominators for Neonatal Intensive Care Unit (NICU)
6,000
6,000
9
9
4
4
216,000
216,000
0
57.117
Denominators for Specialty Care Area (SCA)
6,000
6,000
9
9
5
5
270,000
270,000
0
57.118
Denominators for Intensive Care Unit (ICU)/Other locations (not NICU or SCA)
6,000
6,000
18
18
5
5
540,000
540,000
0
57.119
Denominator for Outpatient Dialysis
225
500
9
12
5/60
5/60
169
500
331
57.120
Surgical Site Infection (SSI)
6,000
6,000
27
27
30/60
32/60
81,000
86,400
5,400
57.121
Denominator for Procedure
6,000
6,000
540
540
8/60
10/60
432,000
540,000
108,000
57.123
Antimicrobial Use and Resistance (AUR)-Microbiology Data
Electronic Upload Specification Tables
6,000
6,000
45
12
3
5/60
810,000
6,000
(804,000)
57.124
Antimicrobial Use and Resistance (AUR)-Pharmacy Data
Electronic Upload Specification Tables
6,000
6,000
36
12
2
5/60
432,000
6,000
(426,000)
57.125
Central Line Insertion Practices Adherence Monitoring
6,000
6,000
100
100
10/60
5/60
100,000
50,000
(50,000)
57.126
MDRO or CDI Infection Form
6,000
6,000
72
72
30/60
32/60
216,000
230,400
14,400
57.127
MDRO and CDI Prevention Process and Outcome Measures Monthly Monitoring 
6,000
6,000
24
24
10/60
10/60
24,000
24,000
0
57.128
Laboratory-identified MDRO or CDI Event
6,000
6,000
240
240
30/60
25/60
720,000
600,000
(120,000)
57.130
Vaccination Monthly Monitoring Form–Summary Method
6,000
6,000
5
5
16
14
480,000
420,000
(60,000)
57.131
Vaccination Monthly Monitoring Form–Patient-Level Method
2,000
2,000
5
5
4
2
40,000
20,000
(20,000)
57.132
N/A-Remove from ICR
2,000
0
250
0
5/60
0
41,667
0
(41,667)
57.133
Patient Vaccination
2,000
2,000
250
250
10/60
10/60
83,333
83,333
0
57.135
N/A-Remove from ICR
6,000
0
1
0
1
0
6,000
0
(6,000)
57.136
N/A-Remove from ICR
6,000
0
1
0
1
0
6,000
0
(6,000)
57.137†
Patient Safety Component--Annual Facility Survey for LTCF
-
250
-
1
-
25/60
-
104
104
57.138†
Laboratory-identified MDRO or CDI Event for LTCF
-
250
-
8
-
30/60
-
1,000
1,000
57.139†
MDRO and CDI Prevention Process Measures Monthly Monitoring for LTCF
-
250
-
3
-
7/60
-
88
88
57.140†
Urinary Tract Infection (UTI) for LTCF
-
250
-
9
-
30/60
-
1,125
1,125
57.200
Healthcare Personnel Safety Component Annual Facility Survey
600
6,000
1
1
8
8
4,800
48,000
43,200
57.202
Healthcare Worker Survey
600
600
100
100
10/60
10/60
10,000
10,000
0
57.203
Healthcare Personnel Safety Monthly Reporting Plan
600
600
9
9
10/60
10/60
900
900
0
57.204
Healthcare Worker Demographic Data
600
600
200
200
20/60
20/60
40,000
40,000
0
57.205
Exposure to Blood/Body Fluids
600
600
50
50
1
1
30,000
30,000
0
57.206
Healthcare Worker Prophylaxis/Treatment
600
600
10
10
15/60
15/60
1,500
1,500
0
57.207
Follow-Up Laboratory Testing
600
600
100
100
15/60
15/60
15,000
15,000
0
57.208
Healthcare Worker Vaccination History
600
600
300
300
10/60
10/60
30,000
30,000
0
57.209
Healthcare Worker Influenza Vaccination
600
600
500
500
10/60
10/60
50,000
50,000
0
57.210
Healthcare Worker Prophylaxis/Treatment-Influenza
600
600
50
50
10/60
10/60
5,000
5,000
0
57.211
Pre-season Survey on Influenza Vaccination Programs for Healthcare Personnel
600
600
1
1
10/60
10/60
100
100
0
57.212
Post-season Survey on Influenza Vaccination Programs for Healthcare Personnel
600
600
1
1
10/60
10/60
100
100
0
57.213†
Healthcare Personnel Influenza Vaccination Monthly Summary
-
6,000
-
6
-
2
-
72,000
72,000
57.300 
Hemovigilance Module Annual Survey
500
500
1
1
2
2
1,000
1,000
0
57.301
Hemovigilance Module Monthly Reporting Plan
500
500
12
12
2/60
2/60
200
200
0
57.302
Hemovigilance Module Monthly Incident Summary
500
500
12
12
2
2
12,000
12,000
0
57.303
Hemovigilance Module Monthly Reporting Denominators
500
500
12
12
30/60
30/60
3,000
3,000
0
57.304
Hemovigilance Adverse Reaction
500
500
120
120
10/60
10/60
10,000
10,000
0
57.305
Hemovigilance Incident
500
500
72
72
10/60
10/60
6,000
6,000
0
Total Estimated Annual Burden (Hours)
5,172,244
3,914,125
(1,258,119)
†This is a new form.