Survey of Healthcare-Associated Infections and Antimicrobial Use in U.S. Nursing Homes for use in Exploring the Development of a National Prevalence Model

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Residents by Location Form	Form and Instruction	New	Available
Healthcare Facility Assessment	Form and Instruction	New	Available
Att. H - Information for NHs.docx	Supplementary Document	Uploaded 2016-05-23	Available
Att. F2 - Supplemental Resident Antimicrobial Use Form.docx	Supplementary Document	Uploaded 2016-05-23	Repair queued
Att. F1 - Supplemental_Resident Infection Form.docx	Supplementary Document	Uploaded 2016-05-23	Repair queued
Att. E - Instructions Residents by Location Form.doc	Supplementary Document	Uploaded 2016-05-23	Available
Att. C2 - Supplemental_Healthcare Facility Assessment Variables_EIP.docx	Supplementary Document	Uploaded 2016-05-23	Available
Att. G -- Non-research determination.pdf	Supplementary Document	Uploaded 2016-05-23	Available
HAI nursing home ICR_SuppStateA_OMB_r2.docx	Supporting Statement A	Uploaded 2017-02-17	Available
Att. B - 60-day FRN.pdf	Supplementary Document	Uploaded 2016-05-23	Repair queued
Att. A - Section 301 of the Public Health Service Act (42 USC 241).pdf	Supplementary Document	Uploaded 2016-05-23	Repair queued
HAI nursing home ICR_SuppStateB_OMB_r1.docx	Supporting Statement B	Uploaded 2017-02-17	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
221654	Residents by Location Form	Form and Instruction	New
221653	Healthcare Facility Assessment	Form and Instruction	New

ICR Details

OMB Control No: 0920-1165	ICR Reference No: 201605-0920-012
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 16TM
Title: Survey of Healthcare-Associated Infections and Antimicrobial Use in U.S. Nursing Homes for use in Exploring the Development of a National Prevalence Model
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 02/17/2017
	Date Received in OIRA: 06/03/2016
Terms of Clearance: Approved consistent with the understanding that CDC will solicit expert advice (particularly from survey statisticians) at several stages of the development of this model to derive national estimates of Healthcare-associated infections in nursing facilities based on information collected from 10 state health departments. Prior to dissemination or publication of the national estimate, CDC will have the final estimate and underlying methodology subject to independent expert peer review consistent with OMB’s Information Quality Bulletin for Peer Review, including the charge questions that elicit opinions on the strengths and weakness of the final model, thus informing CDC’s characterization of the uses of the resulting estimates.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/29/2020	36 Months From Approved
Responses	15,400	0	0
Time Burden (Hours)	5,217	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Understanding the scope and magnitude of healthcare-associated infections (HAIs) in patient populations across the spectrum of U.S. healthcare facilities is essential to the development of effective prevention and control strategies and policies. The aim of this study is to conduct a multi-state survey to estimate the burden and describe the epidemiology of healthcare-associated infections (HAI) and antimicrobial use in a sample of nursing homes in ten states. Results will be used to 1) explore the development of an approach to modeling the national burden of HAI. Such estimates may be used to inform state and federal priority setting for public health initiatives to improve HAI prevention, 2) inform development of the CDCs National Healthcare Safety Network, 3) evaluate uptake of antibiotic stewardship activities in nursing homes in 10 states.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: U.S. PHSA
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 12900	03/11/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 34341	05/31/2016
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Healthcare Facility Assessment	NA	Healthcare Facility Assessment (HFA) Form
Residents by Location Form	NA	Residents by Location Form

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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	15,400	0	0	15,400	0	0
Annual Time Burden (Hours)	5,217	0	0	5,217	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: Submission of 0920-16TM is a New ICR.

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Annual Cost to Federal Government: $1,183,292

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)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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: 06/03/2016

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