Change request justification 27July2020

0920-1290 Change Memo - NHSN COVID-19 LTCF_7-23-20.docx

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

Change request justification 27July2020

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: July 24, 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).”


CDC is updating the COVID-19 Module, Long Term Care Facility (LTCF): Resident Impact and Facility Capacity form (CDC 57.144) to add additional lab questions to the Laboratory Testing section. We estimate these changes will add an additional 15 minutes to the total burden for this form. The purpose of adding these questions to the NHSN LTCF COVID-19 Module is to collect information on two issues:

  1. Do LTCFs have enough access to testing for both residents and facility staff, including resources? (e.g., do they appear to have sufficient access to implement CDC testing guidance, or is access to testing a barrier to that?)

  2. How is testing being used for both residents and facility staff? (e.g., do LTCFs seem to be utilizing testing in the way we recommend or not? This might also help interpret the number of cases being reported, but this wasn’t/isn’t primary goal)

We are also making additional edits to the form to improve clarity of two questions in the Resident Impact Section. These minor changes will not impact the burden of information collection.

The previous burden calculated for this entire data collection consisted of 1,298,246 hours. As a result of the changes proposed in this change memo, the new burden will consist of 1,393,627 hours.


Type of Respondent

Form Name

No. of Respondents

No. Responses per Respondent

Avg. Burden per response (in hrs.)

Total Burden (in hrs.)

LTCF personnel

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

9,782

26

35/60

148,360

Business and financial operations occupations

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

2,446

26

35/60

37,098

State and local health department occupations

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

2,446

26

35/60

37,098

Total form burden


222,556


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorWattenmaker, Lauren (CDC/DDID/NCEZID/DHQP)
File Modified0000-00-00
File Created2021-01-13

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