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NHSN COVID-19 Hospital Module - Hospitals (excluding Psychiatric and Rehabilitation Facilities)
[NCEZID] National Healthcare Safety Network (NHSN) Coronavirus (COVID-19) Surveillance in Healthcare Facilities
OMB: 0920-1317
IC ID: 257193
OMB.report
HHS/CDC
OMB 0920-1317
ICR 202309-0920-001
IC 257193
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1317 can be found here:
2024-08-06 - No material or nonsubstantive change to a currently approved collection
2024-04-26 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
NHSN COVID-19 Hospital Module - Hospitals (excluding Psychiatric and Rehabilitation Facilities)
Form and Instruction
NHSN COVID-19 Hospital Module
Hospital COVID Data Form - webform_FINAL.docx
Form and Instruction
NHSN COVID-19 Hospital Module
Hospital COVID Data Form - webform_FINAL.docx
Form and Instruction
0920-1317 COVID-19 Hospital Data Form
Form-COVID-19 Hospital Data Form-Clean Version.docx
Form and Instruction
0920-1317 COVID-19 Hospital Data Form
Form-COVID-19 Hospital Data Form-Clean Version.docx
Form and Instruction
TOI-for Completion of the COVID-19 Hospital Data Reporting Form.docx
TOI COVID-19 Hospital Module Form
IC Document
TOI-for Completion of the COVID-19 Hospital Data Reporting Form.docx
TOI COVID-19 Hospital Module Form
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
NHSN COVID-19 Hospital Module - Hospitals (excluding Psychiatric and Rehabilitation Facilities)
Agency IC Tracking Number:
0920-1317
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Mandatory
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
n/a
NHSN COVID-19 Hospital Module
Hospital COVID Data Form - webform_FINAL.docx
Yes
Yes
Fillable Fileable
Form and Instruction
0920-1317
COVID-19 Hospital Data Form
Form-COVID-19 Hospital Data Form-Clean Version.docx
N/A
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
5,200
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Not-for-profit institutions, Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
1,898,000
0
-292,000
0
0
2,190,000
Annual IC Time Burden (Hours)
2,847,000
0
-438,000
0
0
3,285,000
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
TOI COVID-19 Hospital Module Form
TOI-for Completion of the COVID-19 Hospital Data Reporting Form.docx
09/07/2023
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.