Change Request Justification Enrollment/Instructions

0920-1290 Change Memo - NHSN COVID-19 LTCF_4-30-20.docx

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

Change Request Justification Enrollment/Instructions

OMB: 0920-1290

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Change Memo for

“National Healthcare Safety Network (NHSN) Patient Impact Module for Coronavirus (COVID-19)

Surveillance in Healthcare Facilities”

(OMB Control No. 0920-1290)

Expiration Date: 09/30/2020































Program Contact


Lauren Wattenmaker

Surveillance Branch

Division of Healthcare Quality Promotion

National Center for Emerging and Zoonotic Infectious Diseases

Centers for Disease Control and Prevention

Atlanta, Georgia 30333

Phone: 404-718-5842

Email: [email protected]


Submission Date: April 30, 2020

The Centers for Disease Control and Prevention (CDC), Division of Healthcare Quality Promotion (DHQP) requests a nonmaterial/non-substantive of the currently approved Information Collection Request: “National Healthcare Safety Network (NHSN) Patient Impact Module for Coronavirus (COVID-19) Surveillance in Healthcare Facilities (OMB Control No. 0920-1290).”


As of April 14, 2020, there are approximately 15,446 long term care facilities listed in the CMS Nursing Home Compare database. CMS will require these facilities to participate in data collection and reporting, we estimate that 95% of these facilities will report COVID-19 case data. As of April 29, 2020, there are 3,101 LTCFs enrolled in NHSN. We estimate that an additional 11,500 facilities will enroll in NHSN pursuant to the CMS reporting requirement. This estimate is based on previous response rates for data collections within NHSN completed by NHSN enrolled facilities.


Type of Respondent

Form Name

No. of Respondents

No. Responses per Respondent

Avg. Burden per response (in hrs.)

Total Burden (in hrs.)

LTCF personnel

NHSN and Secure Access Management Services (SAMS) enrollment

11,500

1

60/60

11,500


The original burden calculated for this data collection consisted of 1,051,056 hours. As a result of the changes proposed in this change memo, the new burden will consist of 1,062,556 hours.


Type of Respondent

Form Name

No. of Respondents

No. Responses per Respondent

Avg. Burden per response (in hrs.)

Total Burden (in hrs.)

Microbiologist (IP)

COVID-19 Patient Impact Module Form

2079

180

25/60

155,925

Business and financial operations occupations

COVID-19 Patient Impact Module Form

519

180

25/60

38,925

State and local health department occupations

COVID-19 Patient Impact Module Form

519

180

25/60

38,925

Microbiologist (IP)

COVID-19 Healthcare Worker Form

2079

180

25/60

155,925

Business and financial operations occupations

COVID-19 Healthcare Worker Form

519

180

25/60

38,925

State and local health department occupations

COVID-19 Healthcare Worker Form

519

180

25/60

38,925

Microbiologist (IP)

COVID-19 Supplies Form

2079

180

25/60

155,925

Business and financial operations occupations

COVID-19 Supplies Form

519

180

25/60

38,925

State and local health department occupations

COVID-19 Supplies Form

519

180

25/60

38,925

LTCF personnel

NHSN and Secure Access Management Services (SAMS) enrollment

11,500

1

60/60

11,500

LTCF personnel

COVID-19 Module, Long Term Care Facility: Staff and Personnel Impact form

9,782

26

15

63,583

Business and financial operations occupations

COVID-19 Module, Long Term Care Facility: Staff and Personnel Impact form

2,446

26

15/60

15,899

State and local health department occupations

COVID-19 Module, Long Term Care Facility: Staff and Personnel Impact form

2,446

26

15/60

15,899

LTCF personnel

COVID-19 Module, Long Term Care Facility: Resident Impact and Facility Capacity form

9,782

26

20/60

84,777

Business and financial operations occupations

COVID-19 Module, Long Term Care Facility: Resident Impact and Facility Capacity form

2,446

26

20/60

21,199

State and local health department occupations

COVID-19 Module, Long Term Care Facility: Resident Impact and Facility Capacity form

2,446

26

20/60

21,199

LTCF personnel

COVID-19 Module, Long Term Care Facility: Ventilator Capacity & Supplies form

9,782

26

5/60

21,194

Business and financial operations occupations

COVID-19 Module, Long Term Care Facility: Ventilator Capacity & Supplies form

2,446

26

5/60

5,300

State and local health department occupations

COVID-19 Module, Long Term Care Facility: Ventilator Capacity & Supplies form

2,446

26

5/60

5,300

LTCF personnel

COVID-19 Module, Long Term Care Facility: Supplies & Personal Protective Equipment form

9,782

26

15/60

63,583

Business and financial operations occupations

COVID-19 Module, Long Term Care Facility: Supplies & Personal Protective Equipment form

2,446

26

15/60

15,899

State and local health department occupations

COVID-19 Module, Long Term Care Facility: Supplies & Personal Protective Equipment form

2,446

26

15/60

15,899

Total


1,062,556


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorWattenmaker, Lauren (CDC/DDID/NCEZID/DHQP)
File Modified0000-00-00
File Created2021-01-14

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