Information Collection

Hospital-Acquired Condition Reduction Program-NHSN HAI Measures Validation

IC 231482 under ICR 202405-0938-006 · OMB 0938-1352.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1352 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10668 Hospital-Acquired Condition Reduction Program-NHSN HAI Measures Validation	Form and Instruction
CMS-10668 Cauti Validation Template FY27_CAUTI_ValTemp.xlsx	Form and Instruction
CMS-10668 Cauti Validation Template FY27_CAUTI_ValTemp.xlsx	Form and Instruction
CMS-10668 CDI Validation Template FY27_CDI_ValTemp.xlsx	Form and Instruction
CMS-10668 CDI Validation Template FY27_CDI_ValTemp.xlsx	Form and Instruction
CMS-10668 CLABSI Validation Template FY27_CLABSI_ValTemp.xlsx	Form and Instruction
CMS-10668 CLABSI Validation Template FY27_CLABSI_ValTemp.xlsx	Form and Instruction
CMS-10668 MRSA Validation Template FY27_MRSA_ValTemp.xlsx	Form and Instruction
CMS-10668 MRSA Validation Template FY27_MRSA_ValTemp.xlsx	Form and Instruction
CMS-10668 Measure Exception Form for Healthcare-Associated Infecti FY25_IPPS_MeasureExceptionForm.pdf	Form and Instruction
CMS-10668 Measure Exception Form for Healthcare-Associated Infecti FY25_IPPS_MeasureExceptionForm.pdf	Form and Instruction
CMS-10668 CMS Hospital-Acquired Condition (HAC) Reduction Program FY25_HACRP_ValidReconReqForm.pdf	Form and Instruction
CMS-10668 CMS Hospital-Acquired Condition (HAC) Reduction Program FY25_HACRP_ValidReconReqForm.pdf	Form and Instruction
FY25-HACRP-PRA-Crosswalk.pdf Crosswalk	IC Document
FY25-HACRP-PRA-Crosswalk.pdf Crosswalk	IC Document

IC Title:

Hospital-Acquired Condition Reduction Program-NHSN HAI Measures Validation

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10668	Cauti Validation Template	FY27_CAUTI_ValTemp.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10668	CDI Validation Template	FY27_CDI_ValTemp.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10668	CLABSI Validation Template	FY27_CLABSI_ValTemp.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10668	MRSA Validation Template	FY27_MRSA_ValTemp.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10668	Measure Exception Form for Healthcare-Associated Infection (HAI) Data	FY25_IPPS_MeasureExceptionForm.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10668	CMS Hospital-Acquired Condition (HAC) Reduction Program Validation Review for Reconsideration Request	FY25_HACRP_ValidReconReqForm.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 640

Number of Respondents for Small Entity: 360

Affected Public: Private Sector

Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	640	240	400
Annual IC Time Burden (Hours)	28,840	40	28,800
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Crosswalk	FY25-HACRP-PRA-Crosswalk.pdf	05/21/2024

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