OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

[NCEZID] The National Healthcare Safety Network (NHSN)

ICR 202402-0920-011 · OMB 0920-0666 · Active

Forms and Documents
DocumentTypeStatusAvailability
Form 57.106 57.106 Patient Safety Monthly Reporting Plan Form and Instruction Unchanged Repair queued
Form 57.106 57.106 Patient Safety Monthly Reporting Plan Form and Instruction Unchanged Repair queued
Form CDC 57.302 Hemovigilance Module Monthly Incident Summary Form and Instruction New Available
Form CDC 57.302 Hemovigilance Module Monthly Incident Summary Form and Instruction New Repair queued
Form 57.701 57.701 - Glycemic Control Module-HYPO Annual Survey Form and Instruction Unchanged Repair queued
Form 57.701 57.701 - Glycemic Control Module-HYPO Annual Survey Form and Instruction Unchanged Repair queued
Form 57.700 57.700 - Medication Safety Component FHIR Measure-Glycemic Control Module Hypoglycemia-Infection Preventionist Form and Instruction Unchanged Available
Form 57.700 57.700 - Medication Safety Component FHIR Measure-Glycemic Control Module Hypoglycemia-Infection Preventionist Form and Instruction Unchanged Repair queued
Form 57.700 57.700 - Medication Safety Component FHIR Measure-Glycemic Control Module Hypoglycemia-IT Yearly Maintenance Form and Instruction Unchanged Available
Form 57.700 57.700 - Medication Safety Component FHIR Measure-Glycemic Control Module Hypoglycemia-IT Yearly Maintenance Form and Instruction Unchanged Repair queued
Form 57.700 57.700 - Medication Safety Component FHIR Measure-Glycemic Control Module Hypoglycemia-IT Initial Set up Form and Instruction Unchanged Repair queued
Form 57.700 57.700 - Medication Safety Component FHIR Measure-Glycemic Control Module Hypoglycemia-IT Initial Set up Form and Instruction Unchanged Repair queued
Form 57.600 57.600 - Neonatal Component Late Onset Sepsis Meningitis (LOSMEN) Module CDA Data Collection-Infection Preventionist Form and Instruction Unchanged Available
Form 57.600 57.600 - Neonatal Component Late Onset Sepsis Meningitis (LOSMEN) Module CDA Data Collection-Infection Preventionist Form and Instruction Unchanged Repair queued
Form 57.600 57.600 - Neonatal Component FHIR Measure-Late Onset Sepsis Meningitis (LOSMEN) Module-Infection Preventionist Form and Instruction Unchanged Repair queued
Form 57.600 57.600 - Neonatal Component FHIR Measure-Late Onset Sepsis Meningitis (LOSMEN) Module-Infection Preventionist Form and Instruction Unchanged Repair queued
Form 57.600 57.600 - Neonatal Component FHIR Measure-Late Onset Sepsis Meningitis (LOSMEN) Module-IT Yearly Maintenance Form and Instruction Unchanged Repair queued
Form 57.600 57.600 - Neonatal Component FHIR Measure-Late Onset Sepsis Meningitis (LOSMEN) Module-IT Yearly Maintenance Form and Instruction Unchanged Missing upstream
Form 57.600 57.600 - Neonatal Component FHIR Measure-Late Onset Sepsis Meningitis (LOSMEN) Module-IT Initial Set up Form and Instruction Unchanged Repair queued
Form 57.600 57.600 - Neonatal Component FHIR Measure-Late Onset Sepsis Meningitis (LOSMEN) Module-IT Initial Set up Form and Instruction Unchanged Repair queued
Form 57.145 57.145 - Long Term Care Antimicrobial Use (LTC-AU) Module CDA Form and Instruction Unchanged Repair queued
Form 57.145 57.145 - Long Term Care Antimicrobial Use (LTC-AU) Module CDA Form and Instruction Unchanged Repair queued
Form 57.144 57.144 - Long Term Care Respiratory Tract Infections (RTI) Module Form and Instruction Modified Repair queued
Form 57.144 57.144 - Long Term Care Respiratory Tract Infections (RTI) Module Form and Instruction Modified Repair queued
Form 57.133 57.133 - Patient Safety Component FHIR Measures-VTE Module- Infection Preventionist Form and Instruction Unchanged Available
Form 57.133 57.133 - Patient Safety Component FHIR Measures-VTE Module- Infection Preventionist Form and Instruction Unchanged Missing upstream
Form 57.133 57.133 - Patient Safety Component FHIR Measures-VTE Module-IT Yearly Maintenance Form and Instruction Unchanged Repair queued
Form 57.133 57.133 - Patient Safety Component FHIR Measures-VTE Module-IT Yearly Maintenance Form and Instruction Unchanged Repair queued
Form 57.133 57.133 - Patient Safety Component FHIR Measures-VTE Module-IT Initial Set up Form and Instruction Unchanged Available
Form 57.133 57.133 - Patient Safety Component FHIR Measures-VTE Module-IT Initial Set up Form and Instruction Unchanged Missing upstream
Form 57.132 57.132 - Patient Safety Component FHIR Measures-HOB, HT-CDI Modules-Infection Preventionist Form and Instruction Unchanged Available
Form 57.132 57.132 - Patient Safety Component FHIR Measures-HOB, HT-CDI Modules-Infection Preventionist Form and Instruction Unchanged Repair queued
Form 57.132 57.132 - Patient Safety Component FHIR Measures-HOB, HT-CDI Modules-IT Yearly Maintenance Form and Instruction Unchanged Available
Form 57.132 57.132 - Patient Safety Component FHIR Measures-HOB, HT-CDI Modules-IT Yearly Maintenance Form and Instruction Unchanged Repair queued
Form 57.132 57.132 - Patient Safety Component FHIR Measures-HOB, HT-CDI Modules-IT Initial Set up Form and Instruction Unchanged Available
Form 57.132 57.132 - Patient Safety Component FHIR Measures-HOB, HT-CDI Modules-IT Initial Set up Form and Instruction Unchanged Repair queued
Form 57.130 57.130 - Patient Safety Component CSV Data Collection-Infection Preventionist CSV Data Collection-Infection Preventionist Form and Instruction Unchanged Available
Form 57.130 57.130 - Patient Safety Component CSV Data Collection-Infection Preventionist CSV Data Collection-Infection Preventionist Form and Instruction Unchanged Repair queued
Form 57.130 57.130 - Patient Safety Component FHIR Measure Respiratory Pathogens Surveillance (RPS)-Infection Preventionist Form and Instruction Unchanged Repair queued
Form 57.130 57.130 - Patient Safety Component FHIR Measure Respiratory Pathogens Surveillance (RPS)-Infection Preventionist Form and Instruction Unchanged Repair queued
Form 57.130 57.130 - Patient Safety Component FHIR Measure Respiratory Pathogens Surveillance (RPS) - IT Yearly Maintenance Form and Instruction Unchanged Available
Form 57.130 57.130 - Patient Safety Component FHIR Measure Respiratory Pathogens Surveillance (RPS) - IT Yearly Maintenance Form and Instruction Unchanged Repair queued
Form 57.130 57.130 Patient Safety Component FHIR Measure Respiratory Pathogens Surveillance (RPS) - IT Initial Set up Form and Instruction Unchanged Repair queued
Form 57.130 57.130 Patient Safety Component FHIR Measure Respiratory Pathogens Surveillance (RPS) - IT Initial Set up Form and Instruction Unchanged Repair queued
Monthly Survey Patient Days & Nurse Staffing Form and Instruction Unchanged Available
Monthly Survey Patient Days & Nurse Staffing Form and Instruction Unchanged Repair queued
Form 0920-0666 Annual Healthcare Personnel Influenza Vaccination Summary Form and Instruction Unchanged Repair queued
Form 0920-0666 Annual Healthcare Personnel Influenza Vaccination Summary Form and Instruction Unchanged Repair queued
Form 0920-0666 Weekly Resident Influenza Vaccination Cumulative Summary for Long-Term Care Facilities Form and Instruction Unchanged Available
Form 0920-0666 Weekly Resident Influenza Vaccination Cumulative Summary for Long-Term Care Facilities Form and Instruction Unchanged Repair queued
Form 0920-0666 Weekly Healthcare Personnel Influenza Vaccination Cumulative Summary for Long-Term Care Facilities Form and Instruction Unchanged Repair queued
Form 0920-0666 Weekly Healthcare Personnel Influenza Vaccination Cumulative Summary for Long-Term Care Facilities Form and Instruction Unchanged Missing upstream
Form 0920-0666 Weekly Healthcare Personnel Influenza Vaccination Cumulative Summary for Non-Long-Term Care Facilities Form and Instruction Unchanged Repair queued
Form 0920-0666 Weekly Healthcare Personnel Influenza Vaccination Cumulative Summary for Non-Long-Term Care Facilities Form and Instruction Unchanged Available
Form 57.135 57.135 Late Onset Sepsis/Meningitis Denominator Form: Data Table (Monthly) Form and Instruction Unchanged Repair queued
Form 57.135 57.135 Late Onset Sepsis/Meningitis Denominator Form: Data Table (Monthly) Form and Instruction Unchanged Repair queued
Form 57.136 57.136 Long Term Care Facility Component - Respiratory Tract Infection Form and Instruction Unchanged Available
Form 57.136 57.136 Long Term Care Facility Component - Respiratory Tract Infection Form and Instruction Unchanged Repair queued
57.104 NHSN Administrator Change Request Form Form and Instruction Unchanged Available
57.104 NHSN Administrator Change Request Form Form and Instruction Unchanged Missing upstream
Form CDC 55.122 57.122 HAI Progress Report State Health Department Survey Form Unchanged Available
Form CDC 55.122 57.122 HAI Progress Report State Health Department Survey Form Unchanged Missing upstream
Form CDC 57.405 57.405 Outpatient Procedure Component - Surgical Site Infection (SSI) Event Form Unchanged Available
Form CDC 57.405 57.405 Outpatient Procedure Component - Surgical Site Infection (SSI) Event Form Unchanged Repair queued
Form 57.404 57.404 Outpatient Procedure Component - SSI Denominators Form Unchanged Repair queued
Form 57.404 57.404 Outpatient Procedure Component - SSI Denominators Form Unchanged Repair queued
Form 57.507 57.507 Home Dialysis Center Practices Survey Form Unchanged Repair queued
Form 57.507 57.507 Home Dialysis Center Practices Survey Form Unchanged Repair queued
Form 57.320 57.320 Hemovigilance Adverse Reaction - Other Transfusion Reaction Form Unchanged Repair queued
Form 57.320 57.320 Hemovigilance Adverse Reaction - Other Transfusion Reaction Form Unchanged Repair queued
Form CDC 57.319 57.319 Hemovigilance Adverse Reaction - Unknown Transfusion Reaction Form Unchanged Available
Form CDC 57.319 57.319 Hemovigilance Adverse Reaction - Unknown Transfusion Reaction Form Unchanged Repair queued
Form CDC 57.318 57.318 Hemovigilance Adverse Reaction - Transfusion Associated Circulatory Overload Form Modified Available
Form CDC 57.318 57.318 Hemovigilance Adverse Reaction - Transfusion Associated Circulatory Overload Form Modified Repair queued
Form 57.317 57.317 Hemovigilance Adverse Reaction - Transfusion Associated Acute Lung Injury Form Unchanged Available
Form 57.317 57.317 Hemovigilance Adverse Reaction - Transfusion Associated Acute Lung Injury Form Unchanged Repair queued
Form CDC 57.316 57.316 Hemovigilance Adverse Reaction - Transfusion Associated Graft vs. Host Disease Form Unchanged Available
Form CDC 57.316 57.316 Hemovigilance Adverse Reaction - Transfusion Associated Graft vs. Host Disease Form Unchanged Repair queued
Form CDC 57.315 57.315 Hemovigilance Adverse Reaction - Transfusion Associated Dyspnea Form Unchanged Available
Form CDC 57.315 57.315 Hemovigilance Adverse Reaction - Transfusion Associated Dyspnea Form Unchanged Repair queued
Form 57.314 57.314 Hemovigilance Adverse Reaction - Post Transfusion Purpura Form Unchanged Repair queued
Form 57.314 57.314 Hemovigilance Adverse Reaction - Post Transfusion Purpura Form Unchanged Repair queued
Form 57.313 57.313 Hemovigilance Adverse Reaction - Infection Form Unchanged Available
Form 57.313 57.313 Hemovigilance Adverse Reaction - Infection Form Unchanged Repair queued
Form 57.312 57.312 Hemovigilance Adverse Reaction - Hypotensive Transfusion Reaction Form Unchanged Repair queued
Form 57.312 57.312 Hemovigilance Adverse Reaction - Hypotensive Transfusion Reaction Form Unchanged Repair queued
Form CDC 57.311 57.311 Hemovigilance Adverse Reaction - Febrile Non-hemolytic Transfusion Reaction Form Unchanged Repair queued
Form CDC 57.311 57.311 Hemovigilance Adverse Reaction - Febrile Non-hemolytic Transfusion Reaction Form Unchanged Repair queued
Form 57.310 57.310 Hemovigilance Adverse Reaction - Delayed Serologic Transfusion Reaction Form Unchanged Repair queued
Form 57.310 57.310 Hemovigilance Adverse Reaction - Delayed Serologic Transfusion Reaction Form Unchanged Repair queued
Form CDC 57.309 57.309 Hemovigilance Adverse Reaction - Delayed Hemolytic Transfusion Reaction Form Unchanged Available
Form CDC 57.309 57.309 Hemovigilance Adverse Reaction - Delayed Hemolytic Transfusion Reaction Form Unchanged Repair queued
Form 57.308 57.308 Hemovigilance Adverse Reaction - Allergic Transfusion Reaction Form Unchanged Repair queued
Form 57.308 57.308 Hemovigilance Adverse Reaction - Allergic Transfusion Reaction Form Unchanged Missing upstream
Form 57.307 57.307 Hemovigilance Adverse Reaction - Acute Hemolytic Transfusion Reaction Form Unchanged Repair queued
Form 57.307 57.307 Hemovigilance Adverse Reaction - Acute Hemolytic Transfusion Reaction Form Unchanged Repair queued
Form 57.306 57.306 Hemovigilance Module Annual Facility Survey - Non-acute Care Facility Form Unchanged Available
Form 57.306 57.306 Hemovigilance Module Annual Facility Survey - Non-acute Care Facility Form Unchanged Repair queued
Form 57.129 57.129_Adult Sepsis_BLANK Form Unchanged Repair queued
Form 57.129 57.129_Adult Sepsis_BLANK Form Unchanged Repair queued
Form CDC 57.115 57.115 Custom Event Form Unchanged Repair queued
Form CDC 57.115 57.115 Custom Event Form Unchanged Repair queued
Form 57.113 57.113 Pediatric Ventilator-Associated Event (PedVAE) Form and Instruction Unchanged Available
Form 57.113 57.113 Pediatric Ventilator-Associated Event (PedVAE) Form and Instruction Unchanged Repair queued
Form CDC 57.506 57.506 Dialysis Patient Influenza Vaccination Denominator Form Unchanged Available
Form CDC 57.506 57.506 Dialysis Patient Influenza Vaccination Denominator Form Unchanged Repair queued
Form CDC 57.505 57.505 Dialysis Patient Influenza Vaccination Form Unchanged Repair queued
Form CDC 57.505 57.505 Dialysis Patient Influenza Vaccination Form Unchanged Repair queued
Form CDC 57.504 57.504 Prevention Process Measures Monthly Monitoring for Dialysis Form Unchanged Repair queued
Form CDC 57.504 57.504 Prevention Process Measures Monthly Monitoring for Dialysis Form Unchanged Repair queued
Form CDC 57.501 57.501 Dialysis Monthly Reporting Plan Form Unchanged Repair queued
Form CDC 57.501 57.501 Dialysis Monthly Reporting Plan Form Unchanged Missing upstream
Form CDC 57.403 57.403 Outpatient Procedure Component - Monthly Denominators and Summary Form Unchanged Repair queued
Form CDC 57.403 57.403 Outpatient Procedure Component - Monthly Denominators and Summary Form Unchanged Repair queued
Form CDC 57.402 57.402 Outpatient Procedure Component Event Form Unchanged Available
Form CDC 57.402 57.402 Outpatient Procedure Component Event Form Unchanged Repair queued
Form CDC 57.401 57.401 Outpatient Procedure - Monthly Reporting Plan Form Unchanged Available
Form CDC 57.401 57.401 Outpatient Procedure - Monthly Reporting Plan Form Unchanged Repair queued
Form CDC 57.400 57.400 Outpatient Procedure - Annual Facility Survey Form Unchanged Available
Form CDC 57.400 57.400 Outpatient Procedure - Annual Facility Survey Form Unchanged Repair queued
Form 57.151 57.151 Patient Safety Component -- Annual Facility Survey for IRF Form and Instruction Unchanged Repair queued
Form 57.151 57.151 Patient Safety Component -- Annual Facility Survey for IRF Form and Instruction Unchanged Repair queued
Form 57.150 57.150 Patient Safety Component -- Annual Facility Survey for LTAC Form and Instruction Unchanged Repair queued
Form 57.150 57.150 Patient Safety Component -- Annual Facility Survey for LTAC Form and Instruction Unchanged Repair queued
Form CDC 57.143 57.143 Prevention Process Measures Monthly Monitoring for LTCF Form Unchanged Available
Form CDC 57.143 57.143 Prevention Process Measures Monthly Monitoring for LTCF Form Unchanged Repair queued
Form CDC 57.142 57.142 Denominators for LTCF Locations Form Modified Available
Form CDC 57.142 57.142 Denominators for LTCF Locations Form Modified Repair queued
Form CDC 57.141 57.141 Monthly Reporting Plan for LTCF Form Modified Repair queued
Form CDC 57.141 57.141 Monthly Reporting Plan for LTCF Form Modified Repair queued
Form 57.112 57.112 Ventilator-Associated Event (VAE) Form and Instruction Unchanged Available
Form 57.112 57.112 Ventilator-Associated Event (VAE) Form and Instruction Unchanged Repair queued
Form CDC 57.139 57.139 MDRO and CDI Prevention Process Measures Monthly for LTCF Form Unchanged Repair queued
Form CDC 57.139 57.139 MDRO and CDI Prevention Process Measures Monthly for LTCF Form Unchanged Repair queued
Form CDC 57.138 57.138 Laboratory-Identified MDRO or CDI Event for LTCF Form Unchanged Repair queued
Form CDC 57.138 57.138 Laboratory-Identified MDRO or CDI Event for LTCF Form Unchanged Missing upstream
Form CDC 57.137 57.137 Long Term care Facility Component--Annual Facility Survey Form Unchanged Available
Form CDC 57.137 57.137 Long Term care Facility Component--Annual Facility Survey Form Unchanged Repair queued
Form CDC 57.305 57.305 Hemovigilance Incident Form Unchanged Repair queued
Form CDC 57.305 57.305 Hemovigilance Incident Form Unchanged Repair queued
Form CDC 57.303 57.303 Hemovigilance Module Monthly Reporting Denominators Form and Instruction Unchanged Available
Form CDC 57.303 57.303 Hemovigilance Module Monthly Reporting Denominators Form and Instruction Unchanged Missing upstream
Form 57.301 57.301 Hemovigilance Module Monthly Reporting Plan Form and Instruction Unchanged Repair queued
Form 57.301 57.301 Hemovigilance Module Monthly Reporting Plan Form and Instruction Unchanged Repair queued
Form CDC 57.300 57.300 Hemovigilance Module Annual Survey -- Acute Care Facility Form Unchanged Available
Form CDC 57.300 57.300 Hemovigilance Module Annual Survey -- Acute Care Facility Form Unchanged Repair queued
Form CDC 57.200 57.200 Healthcare Personnel Safety Component Facility Survey Form Unchanged Repair queued
Form CDC 57.200 57.200 Healthcare Personnel Safety Component Facility Survey Form Unchanged Repair queued
Form CDC 57.204 57.204 Healthcare Worker Demographic Data Form Unchanged Available
Form CDC 57.204 57.204 Healthcare Worker Demographic Data Form Unchanged Repair queued
Form CDC 57.206 57.206 Healthcare Worker Prophylaxis/Treatment Form Unchanged Available
Form CDC 57.206 57.206 Healthcare Worker Prophylaxis/Treatment Form Unchanged Repair queued
Form CDC 57.205 57.205 Exposure to Blood and Body Fluids Form Unchanged Repair queued
Form CDC 57.205 57.205 Exposure to Blood and Body Fluids Form Unchanged Repair queued
Form CDC 57.105 57.105 Group Contact Information Form Unchanged Repair queued
Form CDC 57.105 57.105 Group Contact Information Form Unchanged Repair queued
Form 57.140 57.140 Urinary Tract Infection (UTI) for LTCF Form and Instruction Unchanged Repair queued
Form 57.140 57.140 Urinary Tract Infection (UTI) for LTCF Form and Instruction Unchanged Repair queued
Form 57.103 57.103 Patient Safety Component - Annual Hospital Survey Form and Instruction Unchanged Available
Form 57.103 57.103 Patient Safety Component - Annual Hospital Survey Form and Instruction Unchanged Repair queued
Form CDC 57.101 57.101 Facility Contact Information Form Unchanged Available
Form CDC 57.101 57.101 Facility Contact Information Form Unchanged Missing upstream
Form 57.124 57.124 Antimicrobial Use and Resistence (AUR) - Pharmacy Data Form and Instruction Unchanged Repair queued
Form 57.124 57.124 Antimicrobial Use and Resistence (AUR) - Pharmacy Data Form and Instruction Unchanged Missing upstream
Form 57.123 57.123 Antimicrobial Use and Resistance (AUR) - Microbiology Data Upload Tables Form and Instruction Unchanged Available
Form 57.123 57.123 Antimicrobial Use and Resistance (AUR) - Microbiology Data Upload Tables Form and Instruction Unchanged Missing upstream
Form CDC 57.100 57.100 NHSN Registration Form Form Unchanged Available
Form CDC 57.100 57.100 NHSN Registration Form Form Unchanged Repair queued
Form 57.121 57.121 Denominators for Procedure Form and Instruction Unchanged Available
Form 57.121 57.121 Denominators for Procedure Form and Instruction Unchanged Repair queued
Form CDC 57.128 Rev 7, 57.128 Laboratory Identified or CDI MDRO Event Form and Instruction Unchanged Repair queued
Form CDC 57.128 Rev 7, 57.128 Laboratory Identified or CDI MDRO Event Form and Instruction Unchanged Missing upstream
Form CDC 57.120 57.120 Surgical Site Infection (SSI) Form Unchanged Available
Form CDC 57.120 57.120 Surgical Site Infection (SSI) Form Unchanged Repair queued
Form CDC 57.126 57.126 MDRO or CDI Infection Event Form Unchanged Available
Form CDC 57.126 57.126 MDRO or CDI Infection Event Form Unchanged Repair queued
Form CDC 57.503 57.503 Denominators for Outpatient Dialysis Form Unchanged Repair queued
Form CDC 57.503 57.503 Denominators for Outpatient Dialysis Form Unchanged Repair queued
Form CDC 57.127 57.127 MDRO and CDI Prevention Process and Outcome Measures Monthly Monitoring Form Unchanged Repair queued
Form CDC 57.127 57.127 MDRO and CDI Prevention Process and Outcome Measures Monthly Monitoring Form Unchanged Repair queued
Form CDC 57.118 57.118 Denominators for Intensive Care Unit (ICU) Other Locations (Not NICU or SCA) Form Unchanged Repair queued
Form CDC 57.118 57.118 Denominators for Intensive Care Unit (ICU) Other Locations (Not NICU or SCA) Form Unchanged Repair queued
Form CDC 57.207 57.207 Follow-up Laboratory Testing Form Unchanged Repair queued
Form CDC 57.207 57.207 Follow-up Laboratory Testing Form Unchanged Repair queued
Form CDC 57.117 57.117 Denominators for Specialty Care Area (SCA)/Onocology (ONC) Form Unchanged Available
Form CDC 57.117 57.117 Denominators for Specialty Care Area (SCA)/Onocology (ONC) Form Unchanged Repair queued
Form CDC 57.125 57.125 Central Line Insertion Practices Adherence Monitoring Form Form Unchanged Available
Form CDC 57.125 57.125 Central Line Insertion Practices Adherence Monitoring Form Form Unchanged Repair queued
Form CDC 57.116 57.116 Denominators for Neonatal Intensive Care Unit (NICU) Form Unchanged Available
Form CDC 57.116 57.116 Denominators for Neonatal Intensive Care Unit (NICU) Form Unchanged Repair queued
Form 57.114 57.114 Urinary Tract Infection (UTI) Form and Instruction Unchanged Repair queued
Form 57.114 57.114 Urinary Tract Infection (UTI) Form and Instruction Unchanged Repair queued
Form CDC 57.210 57.210 Healthcare Worker Prophylaxis/Treatment - Influenza Form Unchanged Available
Form CDC 57.210 57.210 Healthcare Worker Prophylaxis/Treatment - Influenza Form Unchanged Missing upstream
Form 57.111 57.111 Pneumonia (includes Any Patient Pneumonia flow Diagram and Infant and Children Pneumonia Flow Diagram) Form and Instruction Unchanged Repair queued
Form 57.111 57.111 Pneumonia (includes Any Patient Pneumonia flow Diagram and Infant and Children Pneumonia Flow Diagram) Form and Instruction Unchanged Repair queued
Form CDC 57.502 57.502 Dialysis Event Form and Instruction Unchanged Repair queued
Form CDC 57.502 57.502 Dialysis Event Form and Instruction Unchanged Repair queued
Form 57.108 57.108 Primary Bloodstream Infection (BSI) Form and Instruction Unchanged Repair queued
Form 57.108 57.108 Primary Bloodstream Infection (BSI) Form and Instruction Unchanged Missing upstream
Form 57.500 57.500 Outpatient Dialysis Center Practices Survey Form and Instruction Unchanged Available
Form 57.500 57.500 Outpatient Dialysis Center Practices Survey Form and Instruction Unchanged Repair queued
Form CDC 57.203 57.203 Healthcare Personnel Safety Reporting Plan Form Unchanged Repair queued
Form CDC 57.203 57.203 Healthcare Personnel Safety Reporting Plan Form Unchanged Repair queued
Change Memo for CDC NHSN OMB Package 0920-0666_2024_FINAL_final.docx Justification for No Material/Nonsubstantive Change Uploaded 2024-02-28 Repair queued
Change Memo for CDC NHSN OMB Package 0920-0666_2024_FINAL_final.docx Justification for No Material/Nonsubstantive Change Uploaded 2024-02-28 Repair queued
FHIR Measures Data Dictionary _HOB, HT-CDI, VTE, LOSMEN, Hypo.xlsx Supplementary Document Uploaded 2023-11-14 Repair queued
FHIR Measures Data Dictionary _HOB, HT-CDI, VTE, LOSMEN, Hypo.xlsx Supplementary Document Uploaded 2023-11-14 Missing upstream
FHIR Measures Data Dictionary (RPS)_09_27_2023.xlsx Supplementary Document Uploaded 2023-11-14 Available
FHIR Measures Data Dictionary (RPS)_09_27_2023.xlsx Supplementary Document Uploaded 2023-11-14 Repair queued
H. Privacy Impact Assessment.pdf Supplementary Document Uploaded 2023-11-14 Available
H. Privacy Impact Assessment.pdf Supplementary Document Uploaded 2023-11-14 Repair queued
G2. NHSN 308d Request for Extension and Ammendment.docx Supplementary Document Uploaded 2023-11-14 Available
G2. NHSN 308d Request for Extension and Ammendment.docx Supplementary Document Uploaded 2023-11-14 Missing upstream
G1. NHSN 308d Approval 2015.pdf Supplementary Document Uploaded 2023-11-14 Available
G1. NHSN 308d Approval 2015.pdf Supplementary Document Uploaded 2023-11-14 Missing upstream
F3. Human Subjects Determination.pdf Supplementary Document Uploaded 2023-11-14 Available
F3. Human Subjects Determination.pdf Supplementary Document Uploaded 2023-11-14 Repair queued
F2. Report of End of Human Research Review 0.1253.docx Supplementary Document Uploaded 2023-11-14 Repair queued
F2. Report of End of Human Research Review 0.1253.docx Supplementary Document Uploaded 2023-11-14 Missing upstream
F1. Closure CDC Protocol # 4062.docx Supplementary Document Uploaded 2023-11-14 Repair queued
F1. Closure CDC Protocol # 4062.docx Supplementary Document Uploaded 2023-11-14 Repair queued
D. Explanation for Program Changes or Adjustments.docx Supplementary Document Uploaded 2023-11-14 Available
D. Explanation for Program Changes or Adjustments.docx Supplementary Document Uploaded 2023-11-14 Repair queued
B. Published 60-Day Federal Register.pdf Supplementary Document Uploaded 2023-11-14 Available
B. Published 60-Day Federal Register.pdf Supplementary Document Uploaded 2023-11-14 Repair queued
A3. 42 USC 242m.pdf Supplementary Document Uploaded 2023-11-14 Available
A3. 42 USC 242m.pdf Supplementary Document Uploaded 2023-11-14 Repair queued
A2. 42 USC 242k.pdf Supplementary Document Uploaded 2023-11-14 Available
A2. 42 USC 242k.pdf Supplementary Document Uploaded 2023-11-14 Repair queued
A1. 42 USC 242b.pdf Supplementary Document Uploaded 2023-11-14 Available
A1. 42 USC 242b.pdf Supplementary Document Uploaded 2023-11-14 Missing upstream
Supporting Statement B 0920-0666 October 2023.docx Supporting Statement B Uploaded 2024-02-15 Repair queued
Supporting Statement B 0920-0666 October 2023.docx Supporting Statement B Uploaded 2024-02-15 Missing upstream
Supporting Statement A 0920-0666 October 2023_final.docx Supporting Statement A Uploaded 2023-11-16 Available
Supporting Statement A 0920-0666 October 2023_final.docx Supporting Statement A Uploaded 2023-11-16 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
7134 57.106 Patient Safety Monthly Reporting Plan Form and Instruction Unchanged
7134 57.106 Patient Safety Monthly Reporting Plan Form and Instruction Unchanged
265665 Hemovigilance Module Monthly Incident Summary Form and Instruction New
265665 Hemovigilance Module Monthly Incident Summary Form and Instruction New
263469 Billing Code Data: 837I Upload Other-Template Unchanged
263468 57.701 - Glycemic Control Module-HYPO Annual Survey Form and Instruction Unchanged
263468 57.701 - Glycemic Control Module-HYPO Annual Survey Form and Instruction Unchanged
263467 57.700 - Medication Safety Component FHIR Measure-Glycemic Control Module Hypoglycemia-Infection Preventionist Form and Instruction Unchanged
263467 57.700 - Medication Safety Component FHIR Measure-Glycemic Control Module Hypoglycemia-Infection Preventionist Form and Instruction Unchanged
263466 57.700 - Medication Safety Component FHIR Measure-Glycemic Control Module Hypoglycemia-IT Yearly Maintenance Form and Instruction Unchanged
263466 57.700 - Medication Safety Component FHIR Measure-Glycemic Control Module Hypoglycemia-IT Yearly Maintenance Form and Instruction Unchanged
263465 57.700 - Medication Safety Component FHIR Measure-Glycemic Control Module Hypoglycemia-IT Initial Set up Form and Instruction Unchanged
263465 57.700 - Medication Safety Component FHIR Measure-Glycemic Control Module Hypoglycemia-IT Initial Set up Form and Instruction Unchanged
263464 57.600 - Neonatal Component Late Onset Sepsis Meningitis (LOSMEN) Module CDA Data Collection-Infection Preventionist Form and Instruction Unchanged
263464 57.600 - Neonatal Component Late Onset Sepsis Meningitis (LOSMEN) Module CDA Data Collection-Infection Preventionist Form and Instruction Unchanged
263463 57.600 - Neonatal Component FHIR Measure-Late Onset Sepsis Meningitis (LOSMEN) Module-Infection Preventionist Form and Instruction Unchanged
263463 57.600 - Neonatal Component FHIR Measure-Late Onset Sepsis Meningitis (LOSMEN) Module-Infection Preventionist Form and Instruction Unchanged
263462 57.600 - Neonatal Component FHIR Measure-Late Onset Sepsis Meningitis (LOSMEN) Module-IT Yearly Maintenance Form and Instruction Unchanged
263462 57.600 - Neonatal Component FHIR Measure-Late Onset Sepsis Meningitis (LOSMEN) Module-IT Yearly Maintenance Form and Instruction Unchanged
263461 57.600 - Neonatal Component FHIR Measure-Late Onset Sepsis Meningitis (LOSMEN) Module-IT Initial Set up Form and Instruction Unchanged
263461 57.600 - Neonatal Component FHIR Measure-Late Onset Sepsis Meningitis (LOSMEN) Module-IT Initial Set up Form and Instruction Unchanged
263460 57.145 - Long Term Care Antimicrobial Use (LTC-AU) Module CDA Form and Instruction Unchanged
263460 57.145 - Long Term Care Antimicrobial Use (LTC-AU) Module CDA Form and Instruction Unchanged
263459 57.144 - Long Term Care Respiratory Tract Infections (RTI) Module Form and Instruction Modified
263459 57.144 - Long Term Care Respiratory Tract Infections (RTI) Module Form and Instruction Modified
263458 57.133 - Patient Safety Component FHIR Measures-VTE Module- Infection Preventionist Form and Instruction Unchanged
263458 57.133 - Patient Safety Component FHIR Measures-VTE Module- Infection Preventionist Form and Instruction Unchanged
263457 57.133 - Patient Safety Component FHIR Measures-VTE Module-IT Yearly Maintenance Form and Instruction Unchanged
263457 57.133 - Patient Safety Component FHIR Measures-VTE Module-IT Yearly Maintenance Form and Instruction Unchanged
263454 57.133 - Patient Safety Component FHIR Measures-VTE Module-IT Initial Set up Form and Instruction Unchanged
263454 57.133 - Patient Safety Component FHIR Measures-VTE Module-IT Initial Set up Form and Instruction Unchanged
263453 57.132 - Patient Safety Component FHIR Measures-HOB, HT-CDI Modules-Infection Preventionist Form and Instruction Unchanged
263453 57.132 - Patient Safety Component FHIR Measures-HOB, HT-CDI Modules-Infection Preventionist Form and Instruction Unchanged
263452 57.132 - Patient Safety Component FHIR Measures-HOB, HT-CDI Modules-IT Yearly Maintenance Form and Instruction Unchanged
263452 57.132 - Patient Safety Component FHIR Measures-HOB, HT-CDI Modules-IT Yearly Maintenance Form and Instruction Unchanged
263450 57.132 - Patient Safety Component FHIR Measures-HOB, HT-CDI Modules-IT Initial Set up Form and Instruction Unchanged
263450 57.132 - Patient Safety Component FHIR Measures-HOB, HT-CDI Modules-IT Initial Set up Form and Instruction Unchanged
263449 57.130 - Patient Safety Component CSV Data Collection-Infection Preventionist CSV Data Collection-Infection Preventionist Form and Instruction Unchanged
263449 57.130 - Patient Safety Component CSV Data Collection-Infection Preventionist CSV Data Collection-Infection Preventionist Form and Instruction Unchanged
263448 57.130 - Patient Safety Component FHIR Measure Respiratory Pathogens Surveillance (RPS)-Infection Preventionist Form and Instruction Unchanged
263448 57.130 - Patient Safety Component FHIR Measure Respiratory Pathogens Surveillance (RPS)-Infection Preventionist Form and Instruction Unchanged
263447 57.130 - Patient Safety Component FHIR Measure Respiratory Pathogens Surveillance (RPS) - IT Yearly Maintenance Form and Instruction Unchanged
263447 57.130 - Patient Safety Component FHIR Measure Respiratory Pathogens Surveillance (RPS) - IT Yearly Maintenance Form and Instruction Unchanged
263439 57.130 Patient Safety Component FHIR Measure Respiratory Pathogens Surveillance (RPS) - IT Initial Set up Form and Instruction Unchanged
263439 57.130 Patient Safety Component FHIR Measure Respiratory Pathogens Surveillance (RPS) - IT Initial Set up Form and Instruction Unchanged
257463 Monthly Survey Patient Days & Nurse Staffing Form and Instruction Unchanged
257463 Monthly Survey Patient Days & Nurse Staffing Form and Instruction Unchanged
246758 Annual Healthcare Personnel Influenza Vaccination Summary Form and Instruction Unchanged
246758 Annual Healthcare Personnel Influenza Vaccination Summary Form and Instruction Unchanged
246757 Weekly Resident Influenza Vaccination Cumulative Summary for Long-Term Care Facilities Form and Instruction Unchanged
246757 Weekly Resident Influenza Vaccination Cumulative Summary for Long-Term Care Facilities Form and Instruction Unchanged
246756 Weekly Healthcare Personnel Influenza Vaccination Cumulative Summary for Long-Term Care Facilities Form and Instruction Unchanged
246756 Weekly Healthcare Personnel Influenza Vaccination Cumulative Summary for Long-Term Care Facilities Form and Instruction Unchanged
246755 Weekly Healthcare Personnel Influenza Vaccination Cumulative Summary for Non-Long-Term Care Facilities Form and Instruction Unchanged
246755 Weekly Healthcare Personnel Influenza Vaccination Cumulative Summary for Non-Long-Term Care Facilities Form and Instruction Unchanged
244476 57.135 Late Onset Sepsis/Meningitis Denominator Form: Data Table (Monthly) Form and Instruction Unchanged
244476 57.135 Late Onset Sepsis/Meningitis Denominator Form: Data Table (Monthly) Form and Instruction Unchanged
238093 57.136 Long Term Care Facility Component - Respiratory Tract Infection Form and Instruction Unchanged
238093 57.136 Long Term Care Facility Component - Respiratory Tract Infection Form and Instruction Unchanged
237430 57.104 NHSN Administrator Change Request Form Form and Instruction Unchanged
237430 57.104 NHSN Administrator Change Request Form Form and Instruction Unchanged
233214 57.122 HAI Progress Report State Health Department Survey Form Unchanged
233214 57.122 HAI Progress Report State Health Department Survey Form Unchanged
228154 57.405 Outpatient Procedure Component - Surgical Site Infection (SSI) Event Form Unchanged
228154 57.405 Outpatient Procedure Component - Surgical Site Infection (SSI) Event Form Unchanged
228153 57.404 Outpatient Procedure Component - SSI Denominators Form Unchanged
228153 57.404 Outpatient Procedure Component - SSI Denominators Form Unchanged
222908 57.507 Home Dialysis Center Practices Survey Form Unchanged
222908 57.507 Home Dialysis Center Practices Survey Form Unchanged
222907 57.320 Hemovigilance Adverse Reaction - Other Transfusion Reaction Form Unchanged
222907 57.320 Hemovigilance Adverse Reaction - Other Transfusion Reaction Form Unchanged
222906 57.319 Hemovigilance Adverse Reaction - Unknown Transfusion Reaction Form Unchanged
222906 57.319 Hemovigilance Adverse Reaction - Unknown Transfusion Reaction Form Unchanged
222905 57.318 Hemovigilance Adverse Reaction - Transfusion Associated Circulatory Overload Form Modified
222905 57.318 Hemovigilance Adverse Reaction - Transfusion Associated Circulatory Overload Form Modified
222904 57.317 Hemovigilance Adverse Reaction - Transfusion Associated Acute Lung Injury Form Unchanged
222904 57.317 Hemovigilance Adverse Reaction - Transfusion Associated Acute Lung Injury Form Unchanged
222903 57.316 Hemovigilance Adverse Reaction - Transfusion Associated Graft vs. Host Disease Form Unchanged
222903 57.316 Hemovigilance Adverse Reaction - Transfusion Associated Graft vs. Host Disease Form Unchanged
222902 57.315 Hemovigilance Adverse Reaction - Transfusion Associated Dyspnea Form Unchanged
222902 57.315 Hemovigilance Adverse Reaction - Transfusion Associated Dyspnea Form Unchanged
222901 57.314 Hemovigilance Adverse Reaction - Post Transfusion Purpura Form Unchanged
222901 57.314 Hemovigilance Adverse Reaction - Post Transfusion Purpura Form Unchanged
222900 57.313 Hemovigilance Adverse Reaction - Infection Form Unchanged
222900 57.313 Hemovigilance Adverse Reaction - Infection Form Unchanged
222899 57.312 Hemovigilance Adverse Reaction - Hypotensive Transfusion Reaction Form Unchanged
222899 57.312 Hemovigilance Adverse Reaction - Hypotensive Transfusion Reaction Form Unchanged
222898 57.311 Hemovigilance Adverse Reaction - Febrile Non-hemolytic Transfusion Reaction Form Unchanged
222898 57.311 Hemovigilance Adverse Reaction - Febrile Non-hemolytic Transfusion Reaction Form Unchanged
222897 57.310 Hemovigilance Adverse Reaction - Delayed Serologic Transfusion Reaction Form Unchanged
222897 57.310 Hemovigilance Adverse Reaction - Delayed Serologic Transfusion Reaction Form Unchanged
222896 57.309 Hemovigilance Adverse Reaction - Delayed Hemolytic Transfusion Reaction Form Unchanged
222896 57.309 Hemovigilance Adverse Reaction - Delayed Hemolytic Transfusion Reaction Form Unchanged
222895 57.308 Hemovigilance Adverse Reaction - Allergic Transfusion Reaction Form Unchanged
222895 57.308 Hemovigilance Adverse Reaction - Allergic Transfusion Reaction Form Unchanged
222894 57.307 Hemovigilance Adverse Reaction - Acute Hemolytic Transfusion Reaction Form Unchanged
222894 57.307 Hemovigilance Adverse Reaction - Acute Hemolytic Transfusion Reaction Form Unchanged
222893 57.306 Hemovigilance Module Annual Facility Survey - Non-acute Care Facility Form Unchanged
222893 57.306 Hemovigilance Module Annual Facility Survey - Non-acute Care Facility Form Unchanged
222892 57.129_Adult Sepsis_BLANK Form Unchanged
222892 57.129_Adult Sepsis_BLANK Form Unchanged
222891 57.115 Custom Event Form Unchanged
222891 57.115 Custom Event Form Unchanged
222890 57.113 Pediatric Ventilator-Associated Event (PedVAE) Form and Instruction Unchanged
222890 57.113 Pediatric Ventilator-Associated Event (PedVAE) Form and Instruction Unchanged
208411 57.506 Dialysis Patient Influenza Vaccination Denominator Form Unchanged
208411 57.506 Dialysis Patient Influenza Vaccination Denominator Form Unchanged
208410 57.505 Dialysis Patient Influenza Vaccination Form Unchanged
208410 57.505 Dialysis Patient Influenza Vaccination Form Unchanged
208409 57.504 Prevention Process Measures Monthly Monitoring for Dialysis Form Unchanged
208409 57.504 Prevention Process Measures Monthly Monitoring for Dialysis Form Unchanged
208408 57.501 Dialysis Monthly Reporting Plan Form Unchanged
208408 57.501 Dialysis Monthly Reporting Plan Form Unchanged
208407 57.403 Outpatient Procedure Component - Monthly Denominators and Summary Form Unchanged
208407 57.403 Outpatient Procedure Component - Monthly Denominators and Summary Form Unchanged
208406 57.402 Outpatient Procedure Component Event Form Unchanged
208406 57.402 Outpatient Procedure Component Event Form Unchanged
208405 57.401 Outpatient Procedure - Monthly Reporting Plan Form Unchanged
208405 57.401 Outpatient Procedure - Monthly Reporting Plan Form Unchanged
208404 57.400 Outpatient Procedure - Annual Facility Survey Form Unchanged
208404 57.400 Outpatient Procedure - Annual Facility Survey Form Unchanged
200382 57.151 Patient Safety Component -- Annual Facility Survey for IRF Form and Instruction Unchanged
200382 57.151 Patient Safety Component -- Annual Facility Survey for IRF Form and Instruction Unchanged
200381 57.150 Patient Safety Component -- Annual Facility Survey for LTAC Form and Instruction Unchanged
200381 57.150 Patient Safety Component -- Annual Facility Survey for LTAC Form and Instruction Unchanged
200380 57.143 Prevention Process Measures Monthly Monitoring for LTCF Form Unchanged
200380 57.143 Prevention Process Measures Monthly Monitoring for LTCF Form Unchanged
200379 57.142 Denominators for LTCF Locations Form Modified
200379 57.142 Denominators for LTCF Locations Form Modified
200378 57.141 Monthly Reporting Plan for LTCF Form Modified
200378 57.141 Monthly Reporting Plan for LTCF Form Modified
200377 57.112 Ventilator-Associated Event (VAE) Form and Instruction Unchanged
200377 57.112 Ventilator-Associated Event (VAE) Form and Instruction Unchanged
197543 57.139 MDRO and CDI Prevention Process Measures Monthly for LTCF Form Unchanged
197543 57.139 MDRO and CDI Prevention Process Measures Monthly for LTCF Form Unchanged
197542 57.138 Laboratory-Identified MDRO or CDI Event for LTCF Form Unchanged
197542 57.138 Laboratory-Identified MDRO or CDI Event for LTCF Form Unchanged
197541 57.137 Long Term care Facility Component--Annual Facility Survey Form Unchanged
197541 57.137 Long Term care Facility Component--Annual Facility Survey Form Unchanged
190364 57.305 Hemovigilance Incident Form Unchanged
190364 57.305 Hemovigilance Incident Form Unchanged
190363 57.303 Hemovigilance Module Monthly Reporting Denominators Form and Instruction Unchanged
190363 57.303 Hemovigilance Module Monthly Reporting Denominators Form and Instruction Unchanged
190361 57.301 Hemovigilance Module Monthly Reporting Plan Form and Instruction Unchanged
190361 57.301 Hemovigilance Module Monthly Reporting Plan Form and Instruction Unchanged
190360 57.300 Hemovigilance Module Annual Survey -- Acute Care Facility Form Unchanged
190360 57.300 Hemovigilance Module Annual Survey -- Acute Care Facility Form Unchanged
183582 57.200 Healthcare Personnel Safety Component Facility Survey Form Unchanged
183582 57.200 Healthcare Personnel Safety Component Facility Survey Form Unchanged
183579 57.204 Healthcare Worker Demographic Data Form Unchanged
183579 57.204 Healthcare Worker Demographic Data Form Unchanged
183578 57.206 Healthcare Worker Prophylaxis/Treatment Form Unchanged
183578 57.206 Healthcare Worker Prophylaxis/Treatment Form Unchanged
183577 57.205 Exposure to Blood and Body Fluids Form Unchanged
183577 57.205 Exposure to Blood and Body Fluids Form Unchanged
183576 57.105 Group Contact Information Form Unchanged
183576 57.105 Group Contact Information Form Unchanged
183573 57.140 Urinary Tract Infection (UTI) for LTCF Form and Instruction Unchanged
183573 57.140 Urinary Tract Infection (UTI) for LTCF Form and Instruction Unchanged
183572 57.103 Patient Safety Component - Annual Hospital Survey Form and Instruction Unchanged
183572 57.103 Patient Safety Component - Annual Hospital Survey Form and Instruction Unchanged
183570 57.101 Facility Contact Information Form Unchanged
183570 57.101 Facility Contact Information Form Unchanged
183568 57.124 Antimicrobial Use and Resistence (AUR) - Pharmacy Data Form and Instruction Unchanged
183568 57.124 Antimicrobial Use and Resistence (AUR) - Pharmacy Data Form and Instruction Unchanged
183566 57.123 Antimicrobial Use and Resistance (AUR) - Microbiology Data Upload Tables Form and Instruction Unchanged
183566 57.123 Antimicrobial Use and Resistance (AUR) - Microbiology Data Upload Tables Form and Instruction Unchanged
183565 57.100 NHSN Registration Form Form Unchanged
183565 57.100 NHSN Registration Form Form Unchanged
183564 57.121 Denominators for Procedure Form and Instruction Unchanged
183564 57.121 Denominators for Procedure Form and Instruction Unchanged
183563 57.128 Laboratory Identified or CDI MDRO Event Form and Instruction Unchanged
183563 57.128 Laboratory Identified or CDI MDRO Event Form and Instruction Unchanged
183562 57.120 Surgical Site Infection (SSI) Form Unchanged
183562 57.120 Surgical Site Infection (SSI) Form Unchanged
183561 57.126 MDRO or CDI Infection Event Form Unchanged
183561 57.126 MDRO or CDI Infection Event Form Unchanged
183560 57.503 Denominators for Outpatient Dialysis Form Unchanged
183560 57.503 Denominators for Outpatient Dialysis Form Unchanged
183559 57.127 MDRO and CDI Prevention Process and Outcome Measures Monthly Monitoring Form Unchanged
183559 57.127 MDRO and CDI Prevention Process and Outcome Measures Monthly Monitoring Form Unchanged
183558 57.118 Denominators for Intensive Care Unit (ICU) Other Locations (Not NICU or SCA) Form Unchanged
183558 57.118 Denominators for Intensive Care Unit (ICU) Other Locations (Not NICU or SCA) Form Unchanged
183557 57.207 Follow-up Laboratory Testing Form Unchanged
183557 57.207 Follow-up Laboratory Testing Form Unchanged
183556 57.117 Denominators for Specialty Care Area (SCA)/Onocology (ONC) Form Unchanged
183556 57.117 Denominators for Specialty Care Area (SCA)/Onocology (ONC) Form Unchanged
183555 57.125 Central Line Insertion Practices Adherence Monitoring Form Form Unchanged
183555 57.125 Central Line Insertion Practices Adherence Monitoring Form Form Unchanged
183554 57.116 Denominators for Neonatal Intensive Care Unit (NICU) Form Unchanged
183554 57.116 Denominators for Neonatal Intensive Care Unit (NICU) Form Unchanged
183551 57.114 Urinary Tract Infection (UTI) Form and Instruction Unchanged
183551 57.114 Urinary Tract Infection (UTI) Form and Instruction Unchanged
183550 57.210 Healthcare Worker Prophylaxis/Treatment - Influenza Form Unchanged
183550 57.210 Healthcare Worker Prophylaxis/Treatment - Influenza Form Unchanged
183549 57.111 Pneumonia (includes Any Patient Pneumonia flow Diagram and Infant and Children Pneumonia Flow Diagram) Form and Instruction Unchanged
183549 57.111 Pneumonia (includes Any Patient Pneumonia flow Diagram and Infant and Children Pneumonia Flow Diagram) Form and Instruction Unchanged
183547 57.502 Dialysis Event Form and Instruction Unchanged
183547 57.502 Dialysis Event Form and Instruction Unchanged
183545 57.108 Primary Bloodstream Infection (BSI) Form and Instruction Unchanged
183545 57.108 Primary Bloodstream Infection (BSI) Form and Instruction Unchanged
183544 57.500 Outpatient Dialysis Center Practices Survey Form and Instruction Unchanged
183544 57.500 Outpatient Dialysis Center Practices Survey Form and Instruction Unchanged
183543 57.203 Healthcare Personnel Safety Reporting Plan Form Unchanged
183543 57.203 Healthcare Personnel Safety Reporting Plan Form Unchanged
ICR Details
StatusActive
Agency/SubagencyHHS/CDC
OMB Control No0920-0666
Type of Information CollectionNo material or nonsubstantive change to a currently approved collection
Previous ICR Reference No202310-0920-013
Agency Tracking No0920-0666
Date Submitted to OIRA2024-02-28
Requested Expiration Date1969-12-31