Information Collection

Hospital-Acquired Condition Reduction Program-NHSN HAI Measures Validation

IC 231482 under ICR 202010-0938-005 · OMB 0938-1352.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1352 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10668 Cauti Validation Template Hospital-Acquired Condition Reduction Program-NHSN HAI Measures Validation	Form and Instruction
Form CMS-10668 CDI Validation Template Hospital-Acquired Condition Reduction Program-NHSN HAI Measures Validation	Form and Instruction
Form CMS-10668 CLABSI Validation Template Hospital-Acquired Condition Reduction Program-NHSN HAI Measures Validation	Form and Instruction
Form CMS-10668 Hospital-Acquired Condition Reduction Program-NHSN HAI Measures Validation	Form and Instruction
Form CMS-10668 MRSA Validation Template Hospital-Acquired Condition Reduction Program-NHSN HAI Measures Validation	Form and Instruction
CMS-10668 Cauti Validation Template FY22_CAUTI_ValTemp_3_4Q_021720.xlsx	Form and Instruction
CMS-10668 Cauti Validation Template FY22_CAUTI_ValTemp_3_4Q_021720.xlsx	Form and Instruction
CMS-10668 CDI Validation Template FY22_CDI_ValTemp_3_4Q_021720.xlsx	Form and Instruction
CMS-10668 CDI Validation Template FY22_CDI_ValTemp_3_4Q_021720.xlsx	Form and Instruction
CMS-10668 CLABSI Validation Template FY22_CLABSI_ValTemp_3_4Q_021720.xlsx	Form and Instruction
CMS-10668 CLABSI Validation Template FY22_CLABSI_ValTemp_3_4Q_021720.xlsx	Form and Instruction
CMS-10668 MRSA Validation Template FY22_MRSA_ValTemp_3_4Q_021720.xlsx	Form and Instruction
CMS-10668 MRSA Validation Template FY22_MRSA_ValTemp_3_4Q_021720.xlsx	Form and Instruction
Cohort 2 Catchement Area ZIP Code Crosswalk (1).xlsx Zipcode Crosswalk	IC Document
Cohort 2 Catchement Area ZIP Code Crosswalk (1).xlsx Zipcode Crosswalk	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Hospital-Acquired Condition Reduction Program-NHSN HAI Measures Validation

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10668	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10668	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10668	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10668	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 400

Number of Respondents for Small Entity: 222

Affected Public: Private Sector

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

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	400	-200	600
Annual IC Time Burden (Hours)	28,800	-14,400	43,200
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Zipcode Crosswalk		05/01/2020

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

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