Information Collection

[NCEZID] Survey of Nursing Homes to Support a Pilot Test of a National Healthcare Safety Network (NHSN) Electronic Health Record (EHR) Implementation Guide (IG)

IC 263139 under ICR 202403-0920-013 · OMB 0920-1071.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1071 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
[NCEZID] Survey of Nursing Homes to Support a Pilot Test of a National Healthcare Safety Network (NHSN) Electronic Health Record (EHR) Implementation Guide (IG)	Form and Instruction
[NCEZID] Survey of Nursing Homes to Support a Pilot Test of a National Healthcare Safety Network (NHSN) Electronic Health Record (EHR) Implementation Guide (IG)	Form and Instruction
NH Survey NHSurvey_CDC NH EHR_dev07_Clean_final_2023Oct13.docx	Form and Instruction
NH Survey NHSurvey_CDC NH EHR_dev07_Clean_final_2023Oct13.docx	Form and Instruction
Service Delivery Fast Track Template_CDC-NHproject_final_2023Oct13.docx GenIC Request Template	IC Document
Service Delivery Fast Track Template_CDC-NHproject_final_2023Oct13.docx GenIC Request Template	IC Document
SurveyInstructions_dev04_Clean.docx Survey Instructions Invite	IC Document
SurveyInstructions_dev04_Clean.docx Survey Instructions Invite	IC Document
Human Subjects Determination.pdf Research Determination	IC Document
Human Subjects Determination.pdf Research Determination	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

[NCEZID] Survey of Nursing Homes to Support a Pilot Test of a National Healthcare Safety Network (NHSN) Electronic Health Record (EHR) Implementation Guide (IG)

Agency IC Tracking Number:

0920-1071-24AT

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	n/a	NH Survey	NHSurvey_CDC NH EHR_dev07_Clean_final_2023Oct13.docx		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: 250

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 70 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	250	250
Annual IC Time Burden (Hours)	83	83
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
GenIC Request Template	Service Delivery Fast Track Template_CDC-NHproject_final_2023Oct13.docx	10/31/2023
Survey Instructions Invite	SurveyInstructions_dev04_Clean.docx	10/31/2023
Research Determination	Human Subjects Determination.pdf	10/31/2023

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.