Change Request Memo - Point of Care Testing 26AUG2020

Change Request Memo 20AUG2020.docx

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

Change Request Memo - Point of Care Testing 26AUG2020

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: August 20, 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 capture access information related to the rapid point-of-care diagnostic testing devices that have been and continue to be sent to LTCFs across the United States. All nursing homes are expected to have a testing device by Sept. 6th, 2020. The new questions will allow NHSN to assess the impact of the devices in terms of nursing home outcomes among residents and healthcare personnel. We estimate these changes will add an additional five minutes to the total burden for this form.

The previous burden calculated for this entire data collection consisted of 1,393,627 hours. As a result of the changes proposed in this change memo, the new burden will consist of 1,647,976 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

40/60

169,555

Business and financial operations occupations

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

2,446

26

40/60

42,397

State and local health department occupations

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

2,446

26

40/60

42,397

Total form burden


254,349


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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