Information Collection

Att D_Healthcare Facility Assessment (HFA)

IC 192451 under ICR 201612-0920-005 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

IC Title:

Att D_Healthcare Facility Assessment (HFA)

Agency IC Tracking Number:

0920-0852

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of 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 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	75	75
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.