Information Collection Request

National Healthcare Safety Network (NHSN) Patient Impact Module for Coronavirus (COVID-19) Surveillance in Healthcare Facilities

ICR 202003-0920-015 · OMB 0920-1290 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 0920-20LW COVID-19 Patient Impact Module Form Form New Available
Att4c_How to Enter and Access COVID Summary Data.docx Supplementary Document Uploaded 2020-03-24 Available
Revised Emergency Request Memo 23MAR2020.docx Supplementary Document Uploaded 2020-03-23 Available
Att6_NHSN Report of End of Human Research Review.docx Supplementary Document Uploaded 2020-03-23 Repair queued
Att5_Closure of CDC Protocol 4062.docx Supplementary Document Uploaded 2020-03-23 Repair queued
Att1c_42 USC 242m.pdf Supplementary Document Uploaded 2020-03-23 Available
Att1b_42 USC 242k.pdf Supplementary Document Uploaded 2020-03-23 Available
Att1a_42 USC 242b.pdf Supplementary Document Uploaded 2020-03-23 Available
Att3_PIA.pdf Supplementary Document Uploaded 2020-03-23 Available
Supporting Statement B NHSN COVID-19_clean.docx Supporting Statement B Uploaded 2020-03-24 Available
Supporting Statement A NHSN COVID-19_clean.docx Supporting Statement A Uploaded 2020-03-25 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
240833 COVID-19 Patient Impact Module Form Form New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
09/30/2020 6 Months From Approved
702,000 0 0
234,000 0 0
0 0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
COVID-19 Patient Impact Module Form 0920-20LW COVID-19 Patient Impact Module Form

table that charts list of burden
  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 702,000 0 0 702,000 0 0
Annual Time Burden (Hours) 234,000 0 0 234,000 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No