Prevalence Survey of Healthcare Associated Infections (HAIs) and Antimicrobial Use in U.S. Acute Care Hospitals

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Patient Information Form (PIF)	Form	Modified	Missing upstream
Healthcare Facility Assessment (HFA)	Form	Modified	Available
Att_I_d_AQUA UTI_Form_Aug22.docx	Supplementary Document	Uploaded 2022-08-02	Repair queued
Att_I_c_AQUA CAP_Form_Aug22.docx	Supplementary Document	Uploaded 2022-08-02	Repair queued
Att_I_b_AQUA Fluoroquinolone Form_Aug22.docx	Supplementary Document	Uploaded 2022-08-02	Repair queued
Att_I_a_AQUA Vancomycin Form_Aug22.docx	Supplementary Document	Uploaded 2022-08-02	Repair queued
Att_H_AQUA General Patient Assessment Form_Aug22.docx	Supplementary Document	Uploaded 2022-08-02	Repair queued
Att_G_AQUA Case Eligibility Form_Aug22.docx	Supplementary Document	Uploaded 2022-08-02	Repair queued
Att_E_HAI Form_Aug22.docx	Supplementary Document	Uploaded 2022-08-02	Missing upstream
Att_C1_EIP HFA_Aug22.docx	Supplementary Document	Uploaded 2022-08-02	Repair queued
Change request_HPPS_HAI and AU_2023_08_02_2022.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2022-08-02	Available
Attachment_I_c_AQUA CAP_Form.docx	Supplementary Document	Uploaded 2021-12-27	Repair queued
HAIPS PTA Signed 2019.pdf	Supplementary Document	Uploaded 2021-12-23	Repair queued
Attachment_I_d_AQUA UTI_Form.docx	Supplementary Document	Uploaded 2021-12-23	Repair queued
Attachment_I_b_AQUA Fluoroquinolone Form.docx	Supplementary Document	Uploaded 2021-12-23	Repair queued
Attachment_M_Draft example of Informaton document distributed to HCF.pdf	Supplementary Document	Uploaded 2021-12-23	Available
Attachment_L_ Non-research_Determination.pdf	Supplementary Document	Uploaded 2021-12-23	Repair queued
Attachment_K_NCHS_Consultation.pdf	Supplementary Document	Uploaded 2021-12-23	Repair queued
Attachment_J_HFA_PIF_Instructions.pdf	Supplementary Document	Uploaded 2021-12-23	Repair queued
Attachment_I_a_AQUA Vancomycin Form.docx	Supplementary Document	Uploaded 2021-12-23	Repair queued
Attachment_H_AQUA General Patient Assessment Form.docx	Supplementary Document	Uploaded 2021-12-23	Repair queued
Attachment_G_AQUA Case Eligibility Form.docx	Supplementary Document	Uploaded 2021-12-23	Repair queued
Attachment_F_AU Form.docx	Supplementary Document	Uploaded 2021-12-23	Repair queued
Attachment_E_HAI Form.docx	Supplementary Document	Uploaded 2021-12-23	Repair queued
Attachment_B_60-Day_0920-0852 Published Federal Register.pdf	Supplementary Document	Uploaded 2021-12-23	Repair queued
Attachment_A2_ARRA.pdf	Supplementary Document	Uploaded 2021-12-23	Repair queued
Attachment_A_Section 301 of the Public Health Service Act (42 USC 241).pdf	Supplementary Document	Uploaded 2021-12-23	Repair queued
SSB_0920_0852_Extension_2021_final.docx	Supporting Statement B	Uploaded 2021-12-23	Repair queued
SSA_0920_0852_Extension_2021_final_ICRO.docx	Supporting Statement A	Uploaded 2021-12-23	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
192452	Patient Information Form (PIF)	Form	Modified
192451	Healthcare Facility Assessment (HFA)	Form	Modified

ICR Details

OMB Control No: 0920-0852	ICR Reference No: 202207-0920-011
Status: Received in OIRA	Previous ICR Reference No: 202112-0920-006
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-0852
Title: Prevalence Survey of Healthcare Associated Infections (HAIs) and Antimicrobial Use in U.S. Acute Care Hospitals
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 08/03/2022

table that charts list comparision

	Requested	Previously Approved
Expiration Date	03/31/2025	03/31/2025
Responses	6,400	6,400
Time Burden (Hours)	1,860	1,860
Cost Burden (Dollars)	65,770	65,770

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Abstract: Preventing healthcare-associated infections (HAIs) and improving antimicrobial use (AU) are CDC and national priorities. An extension of the prevalence survey’s existing OMB approval is sought to allow a repeat HAI and AU Prevalence Survey to be performed in 2020. A repeat survey will allow assessment of changes in HAI and AU prevalence, pathogen distribution, and quality of antimicrobial prescribing. These data will also allow CDC and its partners to continue to monitor HAI and AU trends, to measure progress in meeting national targets, and to further refine prevention strategies.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act
   PL: Pub.L. 111 - 5 1 Name of Law: American Recovery and Reinvestment Act of 2009
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 44723	08/03/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 73286	12/27/2021
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Healthcare Facility Assessment (HFA)	None	Healthcare Facility Assessment (HFA) (modified August 2022)
Patient Information Form (PIF)	None	Patient Information Form (PIF) (modified August 2022)

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ICR Summary of Burden

table that charts list of burden

	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	6,400	6,400	0	0	0	0
Annual Time Burden (Hours)	1,860	1,860	0	0	0	0
Annual Cost Burden (Dollars)	65,770	65,770	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $2,003,060

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Yes

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 08/03/2022

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