Information Collection

Att D_Healthcare Facility Assessment (HFA)

IC 192451 under ICR 201608-0920-019 · OMB 0920-0852.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0852 can be found here:

Documents and Forms

Document Name Document Type
Form Phase 4_HFA_201411 Att D_Healthcare Facility Assessment (HFA) Form
Phase 4_HFA_201411 HAI & Antimicrobial Use Prevalence Survey Healthcare Fac Att D - HFA.pdf Form
Att F - EIP Prevalence Survey Ops Manual.pdf Att F_2015 Operational Manual IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Att D_Healthcare Facility Assessment (HFA)	Agency IC Tracking Number:	0920-0852

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	Phase 4_HFA_20141114	HAI & Antimicrobial Use Prevalence Survey Healthcare Facility Assessment (HFA)	Att D - HFA.pdf		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	100	-400	500
Annual IC Time Burden (Hours)	75	-300	375
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Att F_2015 Operational Manual	Att F - EIP Prevalence Survey Ops Manual.pdf	09/19/2016

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.