Change Request Memo - Emergency

0920-1290 Change Memo - NHSN COVID-19 LTCF_10 15 20.docx

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

Change Request Memo - Emergency

OMB: 0920-1306

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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: October 14, 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 adding a new data collection form to the NHSN COVID-19 Long Term Care Facility (LTCF) Module: Point of Care Testing Results form (CDC 57.1) The data collected via this form will inform state and local health departments as well as federal public health entities about testing results for patients and staff in nursing homes.  This data will be used to identify COVID-19 outbreaks in nursing homes, add to the situational awareness of COVID-19 in jurisdictions, as well as to enable public health agencies to assist in infection prevention and control activities.

Based on the COVID-19 test data reported to the NHSN LTCF Module from September 6, 2020 through October 4, 2020, approximately 5,280 cases in residents and 5,900 cases in staff are reported weekly. We estimate that approximately 95% of test results among nursing home residents and staff are expected to be negative. Based on these figures, we estimate a total of 105,600 resident results and 118,000 total staff results to be reported weekly in accordance with the Centers for Medicare and Medicaid Services (CMS) guidelines for testing frequency. This total of 223,600 weekly staff and resident results equates to approximately 11,627,200 positive and negative results reported annually, accounting for staff and residents who are tested multiple times per CDC and CMS guidelines. CMS guidance on testing recommends that LTCF staff be routinely tested, and NHSN data suggest that staff are tested three times more frequently than residents. Thus, we predict that the staff proportion of all testing is approximately 70%. Of the approximately 13,600 CMS-certified skilled nursing facilities, we estimate that 50% (6,800 facilities) will report point of care test results to NHSN voluntarily. Dividing the total number of annual test results (8,139,040 for staff and 3,488,160 for residents) reported by 6,800 facilities produces an average of 1,197 annual staff responses per facility and an average of 513 annual resident responses per facility.

Once this form is completed once per individual respondent, the demographic data will auto-populate in the NHSN application for subsequent submissions. Thus, the time burden for submissions after the first one will be less than the first submission, for an average of five minutes per response for resident results and ten minutes per response for staff results. The reason for the difference in time burden is because staff responses include more required fields.

The previous burden calculated for this entire data collection consisted of 1,647,976 hours. As a result of the addition proposed in this change memo, the new burden will consist of 3,295,276 hours. The table below reflects additional burden for this new collection only.


Type of Respondent

Form Name

No. of Respondents

No. Responses per Respondent

Avg. Burden per response (in hrs.)

Form Burden (in hrs.)

LTCF personnel (reporting staff test results)

COVID-19 Module, Long Term Care Facility: Point of Care Testing Results

6,800

1,197

10/60

1,356,600

LTCF personnel (reporting resident test results)

COVID-19 Module, Long Term Care Facility: Point of Care Testing Results

6,800

513

5/60

290,700






Form total: 1,647,300 hours


For 30 day Emergency Clearance:

137,275 hours



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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