National Healthcare Safety Network (NHSN) Coronavirus (COVID-19) Surveillance in Healthcare Facilities

ICR 202105-0920-014

OMB: 0920-1317

Federal Form Document

Forms and Documents
Document
Name
Status
Form
New
Form
New
Form and Instruction
Unchanged
Form and Instruction
Unchanged
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Unchanged
Form and Instruction
Unchanged
Form and Instruction
Unchanged
Form and Instruction
Unchanged
Form and Instruction
Unchanged
Form and Instruction
Unchanged
Form and Instruction
Unchanged
Form and Instruction
Unchanged
Form and Instruction
Unchanged
Form and Instruction
Unchanged
Form and Instruction
Unchanged
Form and Instruction
Unchanged
Form and Instruction
Unchanged
Form and Instruction
Unchanged
Form and Instruction
Unchanged
Form and Instruction
Unchanged
Form and Instruction
Unchanged
Form and Instruction
Unchanged
Form and Instruction
Unchanged
Justification for No Material/Nonsubstantive Change
2021-05-28
Justification for No Material/Nonsubstantive Change
2021-02-25
Justification for No Material/Nonsubstantive Change
2021-01-28
Supplementary Document
2020-09-21
Supplementary Document
2020-09-21
Supplementary Document
2020-09-21
Supplementary Document
2020-09-21
Supplementary Document
2020-09-21
Supplementary Document
2020-09-21
Supplementary Document
2020-09-21
Supplementary Document
2020-09-21
Supporting Statement B
2020-09-21
Supporting Statement A
2021-01-15
IC Document Collections
IC ID
Document
Title
Status
247669 New
247668 New
245466 Unchanged
245464 Unchanged
245463 Modified
243719 Modified
243718 Unchanged
243717 Unchanged
243716 Unchanged
243714 Unchanged
243713 Unchanged
243712 Unchanged
243711 Unchanged
243710 Unchanged
243709 Unchanged
243708 Unchanged
243707 Unchanged
243706 Unchanged
243704 Unchanged
243703 Unchanged
243702 Unchanged
243701 Unchanged
243700 Unchanged
243699 Unchanged
243698 Unchanged
ICR Details
0920-1317 202105-0920-014
Received in OIRA 202102-0920-015
HHS/CDC 0920-1317-
National Healthcare Safety Network (NHSN) Coronavirus (COVID-19) Surveillance in Healthcare Facilities
No material or nonsubstantive change to a currently approved collection   No
Regular 05/28/2021
  Requested Previously Approved
01/31/2024 01/31/2024
5,052,366 4,530,322
1,732,245 1,519,695
0 0

The goal of this information collection is to 1) capture the daily, aggregate impact of COVID-19 on healthcare facilities, and 2) monitor medical capacity to respond at local, state, and national levels. This information will be used to inform the overall real-time COVID-19 response efforts and possible resource allocation, and enable state and local health departments to gain immediate access to the COVID-19 data for healthcare facilities within their jurisdiction. This Non-Substantive Change Request is submitted to add a section called Vaccine Status to the Dialysis COVID-19 Outpatient Facility form, and two new forms to the Long-Term Care Facility COVID-19 Module: (1) Veterans Affairs Staff and Personnel COVID-19 Event form and (2) Veterans Affairs Resident COVID-19 Event form.

US Code: 42 USC 242b, k, m Name of Law: The Public Health Service Act
  
None

Not associated with rulemaking

  85 FR 21443 04/17/2020
85 FR 59313 09/21/2020
Yes

25
IC Title Form No. Form Name
Dialysis Component 0920-20LW, 0920-1317, 0920-1317 Dialysis Component ,   COVID-19 Module Dialysis Outpatient Facility ,   COVID-19 Module Dialysis Outpatient Facility Form 27MAY2021
NHSN and Secure Access Management Services (SAMS) enrollment 0920-20LW NHSN Registration Form
Resident Impact and Facility Capacity - Business and Financial Operations Occupations 0920-1317 CDC 57.144, CDC 57.144 Resident Impact and Facility Capacity ,   Resident Impact and Facility Capacity
Resident Impact and Facility Capacity - Business and Financial Operations Occupations retrospective CDC 57.144 Resident Impact and Facility Capacity
Resident Impact and Facility Capacity - LTCF Personnel 0920-1317 CDC 57.144, CDC 57.144 Resident Impact and Facility Capacity ,   Resident Impact and Facility Capacity
Resident Impact and Facility Capacity - LTCF Personnel retrospective CDC 57.144 Resident Impact and Facility Capacity
Resident Impact and Facility Capacity - State and Local Health Dept Occupations 0920-1317 CDC 57.144, CDC 57.144 Resident Impact and Facility Capacity ,   Resident Impact and Facility Capacity
Resident Impact and Facility Capacity - State and Local Health Dept Occupations retrospective CDC 57.144 Resident Impact and Facility Capacity
Resident Therapeutics - Business and Financial Operations Occupations 0920-1317 CDC 57.XXX Long Term Care Facility: Resident Therapeutics
Resident Therapeutics - LTCF Personnel 0920-1317 CDC 57.XXX Long-Term Care Facility: Resident Therapeutics
Resident Therapeutics - State and Local Health Dept. Occupations 0920-1317 CDC 57.XXX Long Term Care Facility: Resident Therapeutics
Staff and Personnel Impact - Business and Financial Operations Occupations CDC 57.145 Staff and Personnel Impact
Staff and Personnel Impact - Business and Financial Operations Occupations retrospective CDC 57.145 Staff and Personnel Impact
Staff and Personnel Impact - LTCF Personnel CDC 57.145 Staff and Personnel Impact
Staff and Personnel Impact - LTCF Personnel retrospective CDC 57.145 Staff and Personnel Impact
Staff and Personnel Impact - State and Local Health Dept Occupations CDC 57.145 Staff and Personnel Impact
Staff and Personnel Impact - State and Local Health Dept Occupations retrospective CDC 57.145 Staff and Personnel Impact
Supplies & Personal Protective Equipment - Business and Financial Operations Occupations CDC 57.146, CDC 57.146 Supplies & Personal Protective Equipment ,   COVID-19 Module - LTCF: Supplies and Personal Protective Equipment
Supplies & Personal Protective Equipment - LTCF Personnel CDC 57.146, CDC 57.146 Supplies & Personal Protective Equipment ,   COVID-19 Module - LTCF: Supplies and Personal Protective Equipment
Supplies & Personal Protective Equipment - State and Local Health Dept Occupations CDC 57.146, CDC 57.146 Supplies & Personal Protective Equipment ,   COVID-19 Module - LTCF: Supplies and Personal Protective Equipment
VA - Resident COVID-19 Event Form - LTCF 0920-1317 VA COVID-19 Resident Event Form
VA - Staff and Personnel COVID-19 Event Form - LTCF 0920-1317 VA - Staff and Personnel COVID-19 Event Form
Ventilator Capacity & Supplies - Business and Financial Operations Occupations CDC 57.147 Ventilator Capacity & Supplies
Ventilator Capacity & Supplies - LCTF Personnel CDC 57.147 Ventilator Capacity & Supplies
Ventilator Capacity & Supplies - State and Local Health Dept Occupations CDC 57.147 Ventilator Capacity & Supplies

  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 5,052,366 4,530,322 0 522,044 0 0
Annual Time Burden (Hours) 1,732,245 1,519,695 0 212,550 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
Burden increase due to modifications made to to add a section called Vaccine Status to the Dialysis COVID-19 Outpatient Facility form, and two new forms to the Long-Term Care Facility COVID-19 Module: (1) Veterans Affairs Staff and Personnel COVID-19 Event form and (2) Veterans Affairs Resident COVID-19 Event form.

$0
No
    Yes
    No
No
No
No
Yes
Jeffrey Zirger 404 639-7118 wtj5[email protected]

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
05/28/2021


© 2021 OMB.report | Privacy Policy