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Privacy Impact Assessment Form
v 1.47.4
Status Draft

Form Number

F-26397

Form Date

Question

Answer

1

OPDIV:

CDC

2

PIA Unique Identifier:

P-6232370-947786

2a Name:

3/18/2019 7:15:27 AM

HAI Prevalence Survey (HAIPS)
General Support System (GSS)
Major Application

3

Minor Application (stand-alone)

The subject of this PIA is which of the following?

Minor Application (child)
Electronic Information Collection
Unknown

3a

Identify the Enterprise Performance Lifecycle Phase
of the system.

Operations and Maintenance
Yes

3b Is this a FISMA-Reportable system?

4

Does the system include a Website or online
application available to and for the use of the general
public?

5

Identify the operator.

6

Point of Contact (POC):

7

Is this a new or existing system?

8

Does the system have Security Authorization (SA)?

8b Planned Date of Security Authorization

No
Yes
No
Agency
Contractor
POC Title

Greg Jones

POC Name

Business Steward

POC Organization NCEZID/DPEI
POC Email

[email protected]

POC Phone

478-278-2972
New
Existing
Yes
No
March 26, 2019
Not Applicable

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11 Describe the purpose of the system.

To estimate Healthcare Associate Illnesses (HAI) prevalence
among inpatients of acute healthcare facilities.

Describe the type of information the system will
collect, maintain (store), or share. (Subsequent
12
questions will identify if this information is PII and ask
about the specific data elements.)
Provide an overview of the system and describe the
13 information it will collect, maintain (store), or share,
either permanently or temporarily.

Data collected also includes information on anti-microbial use
in hospitals, and reasons for use. Demographic information
included is as follows: Age, Race, Ethnicity, Gender, State,
infection types, and antibiotic use. No system user data is
The system is a data collection administered in selected acute
healthcare facilities within the 10 Emerging Infection Program
(EIP) sites (CA, CO, CT, GA, MD, MN, NM, NY, OR, & TN) on the
Yes

14 Does the system collect, maintain, use or share PII?

No

General Comments

OPDIV Senior Official
for Privacy Signature

signed by Jarell
Jarell Oshodi Digitally
Oshodi -S
Date: 2019.03.21 14:01:50
-S
-04'00'

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