NHSN and Secure Access Management Services (SAMS) Enrollment

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

Documents and Forms

Document Name Document Type
Form 0920-1290 NHSN and Secure Access Management Services (SAMS) Enrollment Form and Instruction
0920-1290 NHSN and Secure Access Management Services (SAMS) Enroll NHSN registration form.docx Form and Instruction

Information Collection (IC) Details

IC Title:	NHSN and Secure Access Management Services (SAMS) Enrollment	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-1290	NHSN and Secure Access Management Services (SAMS) Enrollment	NHSN registration form.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 11,500	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	11,500	11,500
Annual IC Time Burden (Hours)	11,500	11,500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.