Change Request Memo 11NOV2020

Change Memo for

“National Healthcare Safety Network (NHSN) Patient Impact Module for Coronavirus (COVID-19)

Surveillance in Healthcare Facilities”

(OMB Control No. 0920-1306)

Expiration Date: 11/30/2020

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: November 9, 2020

The Centers for Disease Control and Prevention (CDC), Division of Healthcare Quality Promotion (DHQP) requests a nonmaterial/non-substantive change 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. 0920-1306).”

CDC is revising collection forms in the NHSN COVID-19 Long-Term Care Facility (LTCF) Module and the Dialysis Module:

• Resident Impact and Facility Capacity form (CDC 57.144)

• Staff and Personnel Impact form (57.145)

• Dialysis Outpatient COVID-19 form

The LTCF forms have been modified to account for current practices in testing and identifying cases among staff and residents. With the additional flu and respiratory illness questions and additional point of care (POC) quantitative questions for residents and staff, the estimated completion burden may increase by 5 minutes, taking into consideration the removal of POC test kit availability and the Suspected variable.

The Dialysis COVID-19 Module form has been modified to reduce the burden on dialysis facilities by making some data fields optional that were previously required.  This updated form will take about half the time to complete than previously estimated, for an average of 10 minutes per response. Additionally, we anticipate that 700 dialysis facilities will need to enroll in NHSN and thus have accounted for the one-time enrollment burden in the table below.

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 (57.144)	11,621	52	45/60	453,219
Business and financial operations occupations	COVID-19 Module, Long Term Care Facility: Resident Impact and Facility Capacity form (57.144)	1,870	52	45/60	72,930
State and local health department occupations	COVID-19 Module, Long Term Care Facility: Resident Impact and Facility Capacity form (57.144)	1,870	52	45/60	72,930
LTCF personnel	COVID-19 Module, Long Term Care Facility Resident Impact and Facility Capacity form (57.144) (retrospective data entry)	5,811	1	45/60	4,358
Business and financial operations occupations	COVID-19 Module, Long Term Care Facility Resident Impact and Facility Capacity form (57.144) (retrospective data entry)	935	1	45/60	701
state and local health department occupations	COVID-19 Module, Long Term Care Facility Resident Impact and Facility Capacity form (57.144) (retrospective data entry)	935	1	45/60	701
LTCF personnel	COVID-19 Module, Long Term Care Facility: Staff and Personnel Impact form (57.145)	11,621	52	20/60	201,431
Business and financial operations occupations	COVID-19 Module, Long Term Care Facility: Staff and Personnel Impact form (57.145)	1,870	52	20/60	32,413
State and local health department occupations	COVID-19 Module, Long Term Care Facility: Staff and Personnel Impact form (57.145)	1,870	52	20/60	32,413
LTCF personnel	COVID-19 Module, Long Term Care Facility Staff and Personnel Impact form (57.145) (retrospective data entry)	5,811	1	20/60	1,937
Business and financial operations occupations	COVID-19 Module, Long Term Care Facility Staff and Personnel Impact form (57.145) (retrospective data entry)	935	1	20/60	312
state and local health department occupations	COVID-19 Module, Long Term Care Facility Staff and Personnel Impact form (57.145) (retrospective data entry)	935	1	20/60	312
Dialysis facility infection preventionists	Dialysis COVID-19 Outpatient Form	4900	104	15/60	127,400
Dialysis facility infection preventionists	NHSN new facility enrollment	700	12	5/60	700