Information Collection Request

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

ICR 202004-0920-004 · OMB 0920-1290 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 0920-1290 COVID-19 Supplies Form - State and Local Health Department Form and Instruction New Available
Form 0920-1290 COVID-19 Supplies Form - Business/Financial Operations Form and Instruction New Available
Form 0920-1290 COVID-19 Supplies Form - Microbiologist Form and Instruction New Available
Form 0920-1290 COVID-19 Healthcare Worker Form - State and Local Health Department Form and Instruction New Available
Form 0920-1290 COVID-19 Healthcare Worker Form - Business/Financial Operations Form and Instruction New Available
Form 0920-1290 COVID-19 Healthcare Worker Form - Microbiologist Form and Instruction New Available
COVID-19 Patient Impact Module Form - State and Local Health Departments Form New Available
HDCommunication FINAL 10APR2020.docx Supplementary Document Uploaded 2020-04-10 Available
0920-1290 Change Request- NHSN COVID-19 Module 04092020.docx Justification for No Material/Nonsubstantive Change Uploaded 2020-04-09 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 Available
Att5_Closure of CDC Protocol 4062.docx Supplementary Document Uploaded 2020-03-23 Available
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_04092020 FINAL.docx Supporting Statement A Uploaded 2020-04-09 Available

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
09/30/2020 09/30/2020 09/30/2020
1,683,180 0 702,000
701,325 0 234,000
0 0 0





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 1,683,180 702,000 0 981,180 0 0
Annual Time Burden (Hours) 701,325 234,000 0 467,325 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No