Prevalence Survey of Healthcare Associated Infections (HAIs) and Antimicrobial Use in U.S. Acute Care Hospitals

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
HAI and Antimicrobial Use Point Prevalence Survey - phase 3	Form	Removed	Available
2011 HIA and Antimicrobial Use Point Prevalence Survey - phase 3 - training and other activities	Form	Removed	Available
Form 1 EIP Personnel Prevalence Survey #2, Phase #3	Form	Removed	Available
Form 1 Infection Control Practioners Prevalence Survey #2, Phase 3	Form	Removed	Available
Patient Information Form (PIF)	Form	Modified	Available
Healthcare Facility Assessment (HFA)	Form	Modified	Available
Reinstatement_0920-0852_SuppStateB_v5_20130821.docx	Supporting Statement B	Uploaded 2013-09-25	Available
AttachmentI_FINAL_0920-0852_NonResearchDeterm.pdf	Supplementary Document	Uploaded 2013-09-25	Available
AttachmentH_FINAL_0920-0852_ NCHSConsultation.rtf	Supplementary Document	Uploaded 2013-09-25	Available
AttachmentI_ FINAL_0920-0852_InformationalDocument.pdf	Supplementary Document	Uploaded 2013-09-25	Available
AttachmentG_FINAL_0920-0852_SupplementalForms_20130726.docx	Supplementary Document	Uploaded 2013-09-25	Available
AttachmentF_FINAL_0920-0852_PTInstructions_v1_20130620.pdf	Supplementary Document	Uploaded 2013-09-25	Available
AttachmentB_FINAL_0920-0852_60 day published.pdf	Supplementary Document	Uploaded 2013-09-25	Available
AttachmentC_FINAL_0920-0852_ARRA_20130618.docx	Supplementary Document	Uploaded 2013-09-25	Available
Attachment A 42 USC 241.pdf	Supplementary Document	Uploaded 2013-09-25	Available
Reinstatement_0920-0852_SuppStateA_v6_20130923.doc	Supporting Statement A	Uploaded 2013-09-25	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
196207	HAI and Antimicrobial Use Point Prevalence Survey - phase 3	Form	Removed
196206	2011 HIA and Antimicrobial Use Point Prevalence Survey - phase 3 - training and other activities	Form	Removed
192454	EIP Personnel Prevalence Survey #2, Phase #3	Form	Removed
192453	Infection Control Practioners Prevalence Survey #2, Phase 3	Form	Removed
192452	Patient Information Form (PIF)	Form	Modified
192451	Healthcare Facility Assessment (HFA)	Form	Modified

ICR Details

OMB Control No: 0920-0852	ICR Reference No: 201310-0920-002
Status: Historical Active	Previous ICR Reference No: 201102-0920-010
Agency/Subagency: HHS/CDC	Agency Tracking No: 20565
Title: Prevalence Survey of Healthcare Associated Infections (HAIs) and Antimicrobial Use in U.S. Acute Care Hospitals
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/02/2013
	Date Received in OIRA: 10/21/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2016	36 Months From Approved
Responses	21,500	0	0
Time Burden (Hours)	6,325	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: The Centers for Disease Control and Prevention (CDC) proposes to conduct two surveys to evaluate the prevalence of healthcare-associated infections (HAIs) and antimicrobial use in acute care hospitals in multiple states. Data collection was discontinued; however, this is a request for reinstatement with minor changes.

---

Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act
   PL: Pub.L. 111 - 5 1 Name of Law: American Recovery and Reinvestment Act of 2009
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 71798	12/04/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 59700	09/27/2013
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Healthcare Facility Assessment (HFA)	none	Healthcare Facility Assessment
Patient Information Form (PIF)	none	Patient Information Form
Infection Control Practioners Prevalence Survey #2, Phase 3	1	2010 HAI & Antimicrobial Use Point Prevalence Survey: Primary Team Data Collection Form
EIP Personnel Prevalence Survey #2, Phase #3	1	2010 HAI & Antimicrobial Use Point Prevalence Survey: Primary Team Data Collection Form
2011 HIA and Antimicrobial Use Point Prevalence Survey - phase 3 - training and other activities	none	2011 HAI and Antimicrobial Use Point Prevalence Survey
HAI and Antimicrobial Use Point Prevalence Survey - phase 3	none	HAI and Antimicrobial Use Point Prevalence Survey

---

ICR Summary of Burden

table that charts list of burden

	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	21,500	0	0	21,500	0	0
Annual Time Burden (Hours)	6,325	0	0	6,325	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a reinstatement with a reduction in burden and minor changes to data collection instruments.

---

Annual Cost to Federal Government: $1,382,732

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Yes

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 10/21/2013

---