Information Collection

Hospital-Acquired Condition Reduction Program-NHSN HAI Measures Validation

IC 231482 under ICR 201805-0938-012 · OMB 0938-1352.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1352 can be found here:

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	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

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 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	600	600
Annual IC Time Burden (Hours)	43,200	43,200
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.