Information Collection Request

The National Healthcare Safety Network (NHSN)

ICR 201908-0920-004 · OMB 0920-0666 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form CDC 57.106 57.106 Patient Safety Monthly Reporting Plan Form and Instruction Unchanged Repair queued
Form 57.136 57.136 Long Term Care Facility Component - Respiratory Tract Infection Form and Instruction New Repair queued
Form 57.104 57.104 NHSN Administrator Change Request Form Form and Instruction New Available
Form CDC 55.122 57.122 HAI Progress Report State Health Department Survey Form Modified Available
Form 57.404 57.405 Outpatient Procedure Component - Surgical Site Infection (SSI) Event Form Modified Available
Form 57.404 57.404 Outpatient Procedure Component - SSI Denominators Form Modified Available
Form 57.507 57.507_HomeDialysisSurv_BLA Form Modified Available
Form 57.320 57.320_HV AR-Other_BLANK Form Unchanged Available
Form CDC 57.319 57.319_HV AR-UNK_BLANK Form Unchanged Available
Form 57.318 57.318_HV AR-TACO_BLANK Form Unchanged Available
Form 57.317 57.317_HV AR-TRALI_BLAN Form Unchanged Available
Form CDC 57.316 57.316_HV AR-TAGVHD_BLAN Form Unchanged Available
Form CDC 57.315 57.315_HV AR-TAD_BLAN Form Unchanged Available
Form 57.314 57.314_HV AR-PTP_BLAN Form Unchanged Available
Form 57.313 57.313_HV AR-Infection_BLAN Form Unchanged Repair queued
Form 57.312 57.312_HV AR-HTR_BLANK Form Unchanged Repair queued
Form CDC 57.311 57.311_HV AR-FNHTR_BLANK Form Unchanged Available
Form 57.310 57.310_HV AR-DSTR_BLANK Form Unchanged Available
Form CDC 57.309 57.309_HV AR-DHTR_BLANK Form Unchanged Available
Form 57.308 57.308_HV AR-Allergic_BLANK Form Unchanged Repair queued
Form 57.307 57.307_HV AR-AHTR_BLANK Form Unchanged Repair queued
Form 57.306 57.306_HV Annual Facility Sur Form Unchanged Available
Form 57.129 57.129_Adult Sepsis_BLANK Form Unchanged Repair queued
Form 57.115 57.115_CUS_BLANK Form Modified Repair queued
Form CDC 57.113 57.113 Pediatric Ventilator-Associated Event (PedVAE) Form Modified Available
Form CDC 57.506 57.506 Dialysis Patient Influenza Vaccination Denominator Form Modified Available
Form CDC 57.505 57.505 Dialysis Patient Influenza Vaccination Form Modified Available
Form CDC 57.504 57.504 Prevention Process Measures Monthly Monitoring for Dialysis Form Modified Available
Form CDC 57.501 57.501 Dialysis Monthly Reporting Plan Form Modified Available
Form CDC 57.403 57.403 Outpatient Procedure Component - Monthly Denominators and Summary Form Modified Available
Form CDC 57.402 57.402 Outpatient Procedure Component Event Form Modified Repair queued
Form CDC 57.401 57.401 Outpatient Procedure - Monthly Reporting Plan Form Modified Available
Form CDC 57.400 57.400 Outpatient Procedure - Annual Facility Survey Form Modified Available
Form CDC 57.151 57.151 Patient Safety Component -- Annual Facility Survey for IRF Form Modified Available
Form CDC 57.150 57.150 Patient Safety Component -- Annual Facility Survey for LTAC Form Modified Available
Form CDC 57.143 57.143 Prevention Process Measures Monthly Monitoring for LTCF Form Modified Available
Form CDC 57.142 57.142 Denominators for LTCF Locations Form Modified Available
Form CDC 57.141 57.141 Monthly Reporting Plan for LTCF Form Modified Repair queued
Form CDC 57.112 57.112 Ventilator-Associated Event (VAE) Form Modified Available
Form CDC 57.139 57.139 MDRO and CDI Prevention Process Measures Monthly for LTCF Form Modified Available
Form CDC 57.138 57.138 Laboratory-Identified MDRO or CDI Event for LTCF Form Modified Repair queued
Form CDC 57.137 57.137 Long Term care Facility Component--Annual Facility Survey Form Modified Available
Form CDC 57.305 57.305 Hemovigilance Incident Form Unchanged Available
Form CDC 57.303 57.303 Hemovigilance Module Monthly Reporting Denominators Form Unchanged Available
Form CDC 57.301 57.301 Hemovigilance Module Monthly Reporting Plan Form Unchanged Available
Form CDC 57.300 57.300 Hemovigilance Module Annual Survey -- Acute Care Facility Form Unchanged Available
Form CDC 57.200 57.200 Healthcare Personnel Safety Component Facility Survey Form Unchanged Available
Form CDC 57.204 57.204 Healthcare Worker Demographic Data Form Unchanged Available
Form CDC 57.206 57.206 Healthcare Worker Prophylaxis/Treatment Form Unchanged Available
Form CDC 57.205 57.205 Exposure to Blood and Body Fluids Form Unchanged Available
Form CDC 57.105 57.105 Group Contact Information Form Unchanged Available
Form CDC 57.140 57.140 Urinary Tract Infection (UTI) for LTCF Form Modified Available
Form CDC 57.103 57.103 Patient Safety Component - Annual Hospital Survey Form Modified Available
Form CDC 57.101 57.101 Facility Contact Information Form Unchanged Available
Form CDC 57.124 57.124 Antimicrobial Use and Resistence (AUR) - Pharmacy Data Form Unchanged Available
Form CDC 57.123 57.123 Antimicrobial Use and Resistance (AUR) - Microbiology Data Upload Tables Form Modified Available
Form CDC 57.100 57.100 NHSN Registration Form Form Unchanged Available
Form CDC 57.121 57.121 Denominators for Procedure Form Modified Available
Form CDC 57.128 Rev 7, 57.128 Laboratory Identified or CDI MDRO Event Form and Instruction Modified Available
Form CDC 57.120 57.120 Surgical Site Infection (SSI) Form Modified Available
Form CDC 57.126 57.126 MDRO or CDI Infection Event Form Modified Available
Form CDC 57.503 57.503 Denominators for Outpatient Dialysis Form Modified Available
Form CDC 57.127 57.127 MDRO and CDI Prevention Process and Outcome Measures Monthly Monitoring Form Modified Available
Form CDC 57.118 57.118 Denominators for Intensive Care Unit (ICU) Other Locations (Not NICU or SCA) Form Modified Available
Form CDC 57.207 57.207 Follow-up Laboratory Testing Form Unchanged Available
Form CDC 57.117 57.117 Denominators for Specialty Care Area (SCA)/Onocology (ONC) Form Modified Available
Form CDC 57.125 57.125 Central Line Insertion Practices Adherence Monitoring Form Form Modified Available
Form CDC 57.116 57.116 Denominators for Neonatal Intensive Care Unit (NICU) Form Modified Repair queued
Form CDC 57.114 57.114 Urinary Tract Infection (UTI) Form Modified Available
Form CDC 57.210 57.210 Healthcare Worker Prophylaxis/Treatment - Influenza Form Unchanged Available
Form CDC 57.111 57.111 Pneumonia (includes Any Patient Pneumonia flow Diagram and Infant and Children Pneumonia Flow Diagram) Form Modified Available
Form CDC 57.502 57.502 Dialysis Event Form Modified Available
Form CDC 57.108 57.108 Primary Bloodstream Infection (BSI) Form Modified Missing upstream
Form CDC 57.500 57.500 Outpatient Dialysis Center Practices Survey Form Modified Available
Form CDC 57.203 57.203 Healthcare Personnel Safety Reporting Plan Form Modified Available
CMS Cross walk 11.16.18.docx Supplementary Document Uploaded 2018-11-29 Available
I. PIA.pdf Supplementary Document Uploaded 2018-10-09 Available
2. NHSN 308d Request for Extension and Ammendment.docx Supplementary Document Uploaded 2017-09-25 Available
1. NHSN 308d Approval 2015.pdf Supplementary Document Uploaded 2017-09-25 Available
1. NHSN 308d Approval 2015.pdf Supplementary Document Uploaded 2018-10-09 Available
2. NHSN - Report of End of Human Research Review 0.1253.docx Supplementary Document Uploaded 2018-10-09 Available
Closure CDC Protocol # 4062.docx Supplementary Document Uploaded 2018-10-09 Available
6. Inpatient Psychiatric Facilities - FLU.pdf Supplementary Document Uploaded 2018-10-09 Repair queued
5. Ambulatory Surgery Centers & Outpatient Acute Care Facility Departments - Flu.pdf Supplementary Document Uploaded 2018-10-09 Repair queued
4. Dialysis Facilities - Dialysis Event, FLU.pdf Supplementary Document Uploaded 2018-10-09 Available
3. Inpatient Rehabiliation Facilities - CAUTI, MRSA LabID, CDI LabID, Flu.pdf Supplementary Document Uploaded 2018-10-09 Available
2. Antimicrobial Use and Resistance.pdf Supplementary Document Uploaded 2018-10-03 Available
1. NHSN Forms used for CMS QRPs State Mandated Reporting FINAL V3.docx Supplementary Document Uploaded 2018-10-03 Available
4. Revision of Estimated Annual Cost Burden.docx Supplementary Document Uploaded 2019-10-10 Available
3. Revision of Estimated Annual Burden Hours.docx Supplementary Document Uploaded 2019-10-10 Available
2. Itemized IC Revisions and Justifications LW clean.docx Supplementary Document Uploaded 2019-12-02 Available
1. Explanations and justifications.docx Supplementary Document Uploaded 2019-10-10 Repair queued
Published 60dy FRN.pdf Supplementary Document Uploaded 2019-10-10 Available
0920-0666 Sup Sta B.docx Supporting Statement B Uploaded 2019-10-10 Available
3. 42 USC 242m.PDF Supplementary Document Uploaded 2018-10-09 Available
2. 42 USC 242k.PDF Supplementary Document Uploaded 2018-10-09 Available
1. 42 USC 242b.PDF Supplementary Document Uploaded 2018-10-09 Available
0920-0666_ Sup Sta A ICRO REVIEW 2 9.17.19.docx Supporting Statement A Uploaded 2019-10-10 Available
IC Document Collections
IC IDCollectionTypeStatusForm
7134 57.106 Patient Safety Monthly Reporting Plan Form and Instruction Unchanged
238093 57.136 Long Term Care Facility Component - Respiratory Tract Infection Form and Instruction New
237430 57.104 NHSN Administrator Change Request Form Form and Instruction New
233214 57.122 HAI Progress Report State Health Department Survey Form Modified
228154 57.405 Outpatient Procedure Component - Surgical Site Infection (SSI) Event Form Modified
228153 57.404 Outpatient Procedure Component - SSI Denominators Form Modified
222908 57.507_HomeDialysisSurv_BLA Form Modified
222907 57.320_HV AR-Other_BLANK Form Unchanged
222906 57.319_HV AR-UNK_BLANK Form Unchanged
222905 57.318_HV AR-TACO_BLANK Form Unchanged
222904 57.317_HV AR-TRALI_BLAN Form Unchanged
222903 57.316_HV AR-TAGVHD_BLAN Form Unchanged
222902 57.315_HV AR-TAD_BLAN Form Unchanged
222901 57.314_HV AR-PTP_BLAN Form Unchanged
222900 57.313_HV AR-Infection_BLAN Form Unchanged
222899 57.312_HV AR-HTR_BLANK Form Unchanged
222898 57.311_HV AR-FNHTR_BLANK Form Unchanged
222897 57.310_HV AR-DSTR_BLANK Form Unchanged
222896 57.309_HV AR-DHTR_BLANK Form Unchanged
222895 57.308_HV AR-Allergic_BLANK Form Unchanged
222894 57.307_HV AR-AHTR_BLANK Form Unchanged
222893 57.306_HV Annual Facility Sur Form Unchanged
222892 57.129_Adult Sepsis_BLANK Form Unchanged
222891 57.115_CUS_BLANK Form Modified
222890 57.113 Pediatric Ventilator-Associated Event (PedVAE) Form Modified
208411 57.506 Dialysis Patient Influenza Vaccination Denominator Form Modified
208410 57.505 Dialysis Patient Influenza Vaccination Form Modified
208409 57.504 Prevention Process Measures Monthly Monitoring for Dialysis Form Modified
208408 57.501 Dialysis Monthly Reporting Plan Form Modified
208407 57.403 Outpatient Procedure Component - Monthly Denominators and Summary Form Modified
208406 57.402 Outpatient Procedure Component Event Form Modified
208405 57.401 Outpatient Procedure - Monthly Reporting Plan Form Modified
208404 57.400 Outpatient Procedure - Annual Facility Survey Form Modified
200382 57.151 Patient Safety Component -- Annual Facility Survey for IRF Form Modified
200381 57.150 Patient Safety Component -- Annual Facility Survey for LTAC Form Modified
200380 57.143 Prevention Process Measures Monthly Monitoring for LTCF Form Modified
200379 57.142 Denominators for LTCF Locations Form Modified
200378 57.141 Monthly Reporting Plan for LTCF Form Modified
200377 57.112 Ventilator-Associated Event (VAE) Form Modified
197543 57.139 MDRO and CDI Prevention Process Measures Monthly for LTCF Form Modified
197542 57.138 Laboratory-Identified MDRO or CDI Event for LTCF Form Modified
197541 57.137 Long Term care Facility Component--Annual Facility Survey Form Modified
190364 57.305 Hemovigilance Incident Form Unchanged
190363 57.303 Hemovigilance Module Monthly Reporting Denominators Form Unchanged
190361 57.301 Hemovigilance Module Monthly Reporting Plan Form Unchanged
190360 57.300 Hemovigilance Module Annual Survey -- Acute Care Facility Form Unchanged
183582 57.200 Healthcare Personnel Safety Component Facility Survey Form Unchanged
183579 57.204 Healthcare Worker Demographic Data Form Unchanged
183578 57.206 Healthcare Worker Prophylaxis/Treatment Form Unchanged
183577 57.205 Exposure to Blood and Body Fluids Form Unchanged
183576 57.105 Group Contact Information Form Unchanged
183573 57.140 Urinary Tract Infection (UTI) for LTCF Form Modified
183572 57.103 Patient Safety Component - Annual Hospital Survey Form Modified
183570 57.101 Facility Contact Information Form Unchanged
183568 57.124 Antimicrobial Use and Resistence (AUR) - Pharmacy Data Form Unchanged
183566 57.123 Antimicrobial Use and Resistance (AUR) - Microbiology Data Upload Tables Form Modified
183565 57.100 NHSN Registration Form Form Unchanged
183564 57.121 Denominators for Procedure Form Modified
183563 57.128 Laboratory Identified or CDI MDRO Event Form and Instruction Modified
183562 57.120 Surgical Site Infection (SSI) Form Modified
183561 57.126 MDRO or CDI Infection Event Form Modified
183560 57.503 Denominators for Outpatient Dialysis Form Modified
183559 57.127 MDRO and CDI Prevention Process and Outcome Measures Monthly Monitoring Form Modified
183558 57.118 Denominators for Intensive Care Unit (ICU) Other Locations (Not NICU or SCA) Form Modified
183557 57.207 Follow-up Laboratory Testing Form Unchanged
183556 57.117 Denominators for Specialty Care Area (SCA)/Onocology (ONC) Form Modified
183555 57.125 Central Line Insertion Practices Adherence Monitoring Form Form Modified
183554 57.116 Denominators for Neonatal Intensive Care Unit (NICU) Form Modified
183551 57.114 Urinary Tract Infection (UTI) Form Modified
183550 57.210 Healthcare Worker Prophylaxis/Treatment - Influenza Form Unchanged
183549 57.111 Pneumonia (includes Any Patient Pneumonia flow Diagram and Infant and Children Pneumonia Flow Diagram) Form Modified
183547 57.502 Dialysis Event Form Modified
183545 57.108 Primary Bloodstream Infection (BSI) Form Modified
183544 57.500 Outpatient Dialysis Center Practices Survey Form Modified
183543 57.203 Healthcare Personnel Safety Reporting Plan Form Modified
ICR Details
0920-0666 201908-0920-004
Historical Active 201808-0920-011
HHS/CDC 0920-0666
The National Healthcare Safety Network (NHSN)
Revision of a currently approved collection   No
Regular
Approved with change 12/02/2019
Retrieve Notice of Action (NOA) 10/11/2019
Previous terms continue: Approved consistent with the understanding that CDC will continue to add language to its website and reports that clearly caveats the interpretation of longitudinal trends due to changes in the number and characteristics of participating hospitals, particularly changes driven by Medicare and State-level reporting.
  Inventory as of this Action Requested Previously Approved
12/31/2022 36 Months From Approved 11/30/2021
5,352,360 0 11,515,655
3,113,631 0 5,397,438
101,009,102 0 191,260,525

The National Healthcare Safety Network (NHSN) is a system designed to accumulate, exchange, and integrate relevant information and resources among private and public stakeholders to support local and national efforts to protect patients and promote healthcare safety. Since 2005, the (NHSN) provides healthcare facilities, states, regions, and the nation with the data desired to identify healthcare-associated infection (HAI) problem areas, measure the progress of prevention efforts, and ultimately eliminate HAIs in conjunction with driving the achievement of the overall mission of the Department of Health and Human Services (DHHS). Enrollment in NHSN has continuously increased, with over 25,000 enrolled healthcare facilities and 21,700 actively reporting healthcare facilities across the U.S. Of these, there are over 5,000 acute care facilities; 7,800 dialysis facilities; 600 long-term acute care facilities; 1,100 inpatient rehabilitation facilities; 800 inpatient psychiatric facilities; 3,100 long-term care facilities; and 6,000 ambulatory surgery facilities. The proposed revisions included in this ICR are designed to (1) increase the overall attainment of CDC’s NHSN HAI surveillance goals and event reporting coverage for all facility types that are active and reporting data to NHSN; (2) to enhance NHSN surveillance and data quality practices exercised by NHSN users and facilities alike; (3) to introduce the new; Neonatal Component, NHSN Facility Administrator Change Request Form, and Long-term Care Facility Form. (4) To update and revise existing survey questions within NHSN’s components by implementing elements of user feedback that has been further analyzed for NHSN and its partnering organizations, intended to advance NHSN data reporting quality for HAI events, dialysis events, and hemovigilance adverse reaction protocols. Lastly, the proposed revisions will further improve the overall quality of existing data collection forms, which are intended to ensure complete data reporting into CDC’s NHSN by all participating facilities.

US Code: 42 USC 242m(d) Name of Law: Public Health Service Act
   US Code: 42 USC 242k Name of Law: Public Health Service Act
   US Code: 42 USC 242b Name of Law: Public Health Service Act
  
None

Not associated with rulemaking

  84 FR 26113 06/05/2019
84 FR 53441 10/07/2019
No

75
IC Title Form No. Form Name
57.311_HV AR-FNHTR_BLANK CDC 57.311 Hemovigilance Adverse Reaction - Febrile Non-hemolytic Transfusion Reaction
57.308_HV AR-Allergic_BLANK 57.308 Hemovigilance Adverse Reaction - Allergic Transfusion Reaction
57.315_HV AR-TAD_BLAN CDC 57.315 Hemovigilance Adverse Reaction - Transfusion Associated Dyspnea
57.122 HAI Progress Report State Health Department Survey CDC 55.122 State Health Department HAI Mandate and Validatyion Survey
57.108 Primary Bloodstream Infection (BSI) CDC 57.108 Primary Bloodstream Infection
57.502 Dialysis Event CDC 57.502 Dialysis Event
57.111 Pneumonia (includes Any Patient Pneumonia flow Diagram and Infant and Children Pneumonia Flow Diagram) CDC 57.111 Pneumonia (PNEU)
57.210 Healthcare Worker Prophylaxis/Treatment - Influenza CDC 57.210 HCW Prophylaxis/Treatment-Influenza
57.307_HV AR-AHTR_BLANK 57.307 Hemovigilance Adverse Reaction - Acute Hemolytic Transfusion Reaction
57.125 Central Line Insertion Practices Adherence Monitoring Form CDC 57.125 Central Line Insertion Practices Adherence Monitoring
57.313_HV AR-Infection_BLAN 57.313 Hemovigilance Adverse Reaction - Infection
57.318_HV AR-TACO_BLANK 57.318 Hemoviligance Adverse Reaction - Transfusion Associated Circulatory Overload
57.319_HV AR-UNK_BLANK CDC 57.319 Hemovigilance Adverse Reaction - Unknown Transfusion Reaction
57.507_HomeDialysisSurv_BLA 57.507 Home Dialysis Center Practices Survey
57.129_Adult Sepsis_BLANK 57.129 Adult Sepsis_
57.114 Urinary Tract Infection (UTI) CDC 57.114 Urinary Tract infection (UTI)
57.118 Denominators for Intensive Care Unit (ICU) Other Locations (Not NICU or SCA) CDC 57.118 Denominators for Intensive Care Unit (ICU)/Other locations (not NICU or SCA)
57.116 Denominators for Neonatal Intensive Care Unit (NICU) CDC 57.116 PedVAE Optional Denominators Neonatal Intensive Care Unit (NICU)
57.117 Denominators for Specialty Care Area (SCA)/Onocology (ONC) CDC 57.117 Denominators for Specialty Care Area (SCA)/Oncology (ONC)
57.207 Follow-up Laboratory Testing CDC 57.207 Follow-up Laboratory Testing
57.127 MDRO and CDI Prevention Process and Outcome Measures Monthly Monitoring CDC 57.127 MDRO and CDI Prevention Process and Outcome Measures Monthly Reporting
57.503 Denominators for Outpatient Dialysis CDC 57.503 Demominators for Dialysis Event Surveillance
57.126 MDRO or CDI Infection Event CDC 57.126 MDRO or CDI Infection Event
57.120 Surgical Site Infection (SSI) CDC 57.120 Surgical Site Infection (SSI)
57.128 Laboratory Identified or CDI MDRO Event CDC 57.128, CDC 57.128 Rev 7, v8.5 Lab ID Event ,   Laboratory-identified MDRO or CDI Event
57.121 Denominators for Procedure CDC 57.121 Denominatoir for Procedure
57.100 NHSN Registration Form CDC 57.100 NHSN Registration Form
57.123 Antimicrobial Use and Resistance (AUR) - Microbiology Data Upload Tables CDC 57.123 Antimicrobial Use and Resistance (AUR): Microbiology Laboratory Data Monthly Electronic Upload Specification Tables
57.124 Antimicrobial Use and Resistence (AUR) - Pharmacy Data CDC 57.124 Antimicrobial Use and Resistance (AUR): Pharmacy Date Monthly Electronice Upload Specification Tables
57.101 Facility Contact Information CDC 57.101 Facility Contact Information
57.103 Patient Safety Component - Annual Hospital Survey CDC 57.103 Annual Hospital Survey - Patient Safety Component
57.140 Urinary Tract Infection (UTI) for LTCF CDC 57.140 Urinary Tract Infection (UTI) for LTCF
57.105 Group Contact Information CDC 57.105 Group Contact Information
57.205 Exposure to Blood and Body Fluids CDC 57.205 Exposure to Blood/Body Fluids
57.206 Healthcare Worker Prophylaxis/Treatment CDC 57.206 Healthcare Worker Prophylaxis/Treatment
57.204 Healthcare Worker Demographic Data CDC 57.204 Healthcare Worker Demographic Data
57.200 Healthcare Personnel Safety Component Facility Survey CDC 57.200 Healthcare Personnel Safety - Annual Facility Survey
57.404 Outpatient Procedure Component - SSI Denominators 57.404 Outpatient Procedure Component - SSI Denominators
57.300 Hemovigilance Module Annual Survey -- Acute Care Facility CDC 57.300 Hemovigilance Module - Annual Survey
57.301 Hemovigilance Module Monthly Reporting Plan CDC 57.301 Hemovigilance Module Monthly Reporting Plan
57.303 Hemovigilance Module Monthly Reporting Denominators CDC 57.303 Hemovigilance Module Monthly Reporting Denominators
57.505 Dialysis Patient Influenza Vaccination CDC 57.505 Dialysis Patient Influenza Vaccination
57.106 Patient Safety Monthly Reporting Plan CDC 57.106 Patient Safety Monthly Reporting Plan
57.401 Outpatient Procedure - Monthly Reporting Plan CDC 57.401 Outpatient Procedure Component - Monthly Reporting Plan
57.501 Dialysis Monthly Reporting Plan CDC 57.501 NHSN Registration Form
57.504 Prevention Process Measures Monthly Monitoring for Dialysis CDC 57.504 Prevention Process Measures Monthly Monitoring for Dialysis
57.203 Healthcare Personnel Safety Reporting Plan CDC 57.203 Healthcare Personnel Safety Monthly Reporting Plan
57.500 Outpatient Dialysis Center Practices Survey CDC 57.500 Outpatient Dialysis Center Practices Survey
57.506 Dialysis Patient Influenza Vaccination Denominator CDC 57.506 Dialysis Patient Influenza Vaccination Denominator
57.113 Pediatric Ventilator-Associated Event (PedVAE) CDC 57.113 Pediatric Ventilator-Associated Event (VAE)
57.151 Patient Safety Component -- Annual Facility Survey for IRF CDC 57.151 Patient Safety Component - Annual Facility Survey for IRF
57.400 Outpatient Procedure - Annual Facility Survey CDC 57.400 Outpatient Procedure Component - Annual Facility Survey
57.402 Outpatient Procedure Component Event CDC 57.402 Outpatient Procedure - Event
57.403 Outpatient Procedure Component - Monthly Denominators and Summary CDC 57.403 Outpatient Procedure - Monthly Denominators and Summary
57.405 Outpatient Procedure Component - Surgical Site Infection (SSI) Event 57.404 Outpatient Procedure Component - SSI Denominators
57.320_HV AR-Other_BLANK 57.320 Hemovigilance Adverse Reaction - Other Transfusion Reaction
57.305 Hemovigilance Incident CDC 57.305 Hemovigilance Module Incident
57.137 Long Term care Facility Component--Annual Facility Survey CDC 57.137 Long-Term Care Facility Component -- Annual Facility Survey
57.138 Laboratory-Identified MDRO or CDI Event for LTCF CDC 57.138 Laboratory-identified MDRO or CDI Event for LTCF
57.139 MDRO and CDI Prevention Process Measures Monthly for LTCF CDC 57.139 MDRO and CDI Prevention Process Measures Monthly Monitoring for LTCF
57.112 Ventilator-Associated Event (VAE) CDC 57.112 Ventilator-Associated Event (VAE)
57.141 Monthly Reporting Plan for LTCF CDC 57.141 Monthly Reporting Plan for LTCF
57.142 Denominators for LTCF Locations CDC 57.142 Denominators for LTCF
57.143 Prevention Process Measures Monthly Monitoring for LTCF CDC 57.143 Prevention Process Measures Monthly Monitoring
57.150 Patient Safety Component -- Annual Facility Survey for LTAC CDC 57.150 Patient Safety Component - Annual Facility Survey for LTAC
57.310_HV AR-DSTR_BLANK 57.310 Hemovigilance Adverse Reaction - Delayed Serologic Transfusion Reaction
57.312_HV AR-HTR_BLANK 57.312 Hemovigilance Adverse Reaction - Hypotensive Transfusion Reaction
57.314_HV AR-PTP_BLAN 57.314 Hwemovilgilance Adverse Reaction - Post Transfusion Purpura
57.316_HV AR-TAGVHD_BLAN CDC 57.316 Hemovigilance Adverse Reaction - Transfusin Associated Graft vs. Host Disease
57.115_CUS_BLANK 57.115 Custom Event
57.317_HV AR-TRALI_BLAN 57.317 Hemovigilance Adverse Reaction - Transfusion Related Acute Lung Injury
57.306_HV Annual Facility Sur 57.306 Hemovigilance Module Annual Survey - Non-acute Care Facility
57.309_HV AR-DHTR_BLANK CDC 57.309 Hemovigilance Adverse Reaction - Delayed Hemolytic Transfusion Reaction
57.104 NHSN Administrator Change Request Form 57.104 FAChangeRequest_BLANK
57.136 Long Term Care Facility Component - Respiratory Tract Infection 57.136 Long-Term Care Facility Component – Respiratory Tract Infection

  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 5,352,360 11,515,655 0 -6,163,295 0 0
Annual Time Burden (Hours) 3,113,631 5,397,438 0 -2,283,807 0 0
Annual Cost Burden (Dollars) 101,009,102 191,260,525 0 -90,251,423 0 0
Yes
Miscellaneous Actions
Yes
Changing Forms
Forty data collection tools under OMB No. 0920-0666 have been revised in this revision request. Ten forms within the NHSN Patient Safety Component are changing with this ICR. Updates were made to the pathogens and susceptibility section for forms (57.111, 57.112, 57.113, 57.114, 57. 115, and 57.120) due to a program-wide name change for the organism from ‘Enterobacter’ to ‘Klebsiella.’ 2. Eight LTCF forms will be updated, two of which (57.138, 57.140), will include an update that will streamline how the facilities document the “Social Security Number” and “Resident type” variables. Three Dialysis component tools will be updated with this ICR. CDC added and revised multiple questions/options on the surveys to better understand possible risk factors for healthcare-associated infections (HAIs), as well as the patient population they serve for surveillance and prevention purposes.

$18,045,604
Yes Part B of Supporting Statement
    Yes
    Yes
No
No
No
Uncollected
Thelma Sims 4046394771

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
10/11/2019