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Hospital-Acquired Condition Reduction Program-NHSN HAI Measures Validation
Quality Measures and Administrative Procedures for the Hospital-Acquired Condition Reduction Program for the FY 2019 IPPS Program Year (CMS-10668)
OMB: 0938-1352
IC ID: 231482
OMB.report
HHS/CMS
OMB 0938-1352
ICR 201805-0938-012
IC 231482
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1352 can be found here:
2024-05-22 - Revision of a currently approved collection
2022-08-24 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
Form CMS-10668
Hospital-Acquired Condition Reduction Program-NHSN HAI Measures Validation
Form and Instruction
CMS-10668 Cauti Validation Template
FY2021_CAUTI_Validation Template_4.12.2018FINAL(508).xlsx
Form and Instruction
CMS-10668 CDI Validation Template
FY2021_CDI_Validation Template_4.12.2018.FINAL(508).xlsx
Form and Instruction
CMS-10668 CLABSI Validation Template
FY2021_CLABSI_Validation Template_4.12.2018.FINAL(508).xlsx
Form and Instruction
CMS-10668 MRSA Validation Template
FY2021_MRSA_Validation Template_4.12.2018.FINAL(508).xlsx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Hospital-Acquired Condition Reduction Program-NHSN HAI Measures Validation
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
CMS-10668
Cauti Validation Template
FY2021_CAUTI_Validation Template_4.12.2018FINAL(508).xlsx
Yes
Yes
Fillable Fileable
Form and Instruction
CMS-10668
CDI Validation Template
FY2021_CDI_Validation Template_4.12.2018.FINAL(508).xlsx
Yes
Yes
Fillable Fileable
Form and Instruction
CMS-10668
CLABSI Validation Template
FY2021_CLABSI_Validation Template_4.12.2018.FINAL(508).xlsx
Yes
Yes
Fillable Fileable
Form and Instruction
CMS-10668
MRSA Validation Template
FY2021_MRSA_Validation Template_4.12.2018.FINAL(508).xlsx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
600
Number of Respondents for Small Entity:
222
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits, Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
100 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
600
0
600
0
0
0
Annual IC Time Burden (Hours)
43,200
0
43,200
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.