Form 57.802 Bed Capacity-IT Initial Set Up

Form Approved

OMB No. 0920-0666

Exp. Date: 12/31/2026

www.cdc.gov/nhsn

NHSN Connectivity Initiative Bed Capacity Form

OrgID:	____
Collection Date:	/_/_/_ 00:00
Extraction Date:	/_/_/_ 00:00
Context:	____
All Beds
All Beds Occupied:	____
All Beds Unoccupied:	____
Adult Beds
Adult Total Occupied:	____
Adult Total Unoccupied:	____
Adult ICU Occupied:	____
Adult ICU Unoccupied:	____
Adult ICU-LOC Occupied:	____
Adult Non-ICU Occupied:	____
Adult Non-ICU Unoccupied:	____
Adult PCU Occupied:	____
Adult PCU Unoccupied:	____
Adult MT/MS Occupied:	____
Adult MT/MS Unoccupied:	____
Adult OBS Occupied:	____
Adult OBS Unoccupied:	____
Pediatric Beds
Peds Total Occupied:	____
Peds Total Unoccupied:	____
Peds ICU Occupied:	____
Peds ICU Unoccupied:	____
Peds ICU-LOC Occupied:	____
Peds Non-ICU Occupied:	____
Peds Non-ICU Unoccupied:	____
Peds PCU Occupied:	____
Peds PCU Unoccupied:	____
Peds MT/MS Occupied:	____
Peds MT/MS Unoccupied:	____
Peds OBS Occupied:	____
Peds OBS Unoccupied:	____
Specialty Beds
Specialty Total Occupied:	____
Specialty Total Unoccupied:	____
Specialty Total Non-Crib Occupied:	____
Specialty Total Non-Crib Unoccupied:	____
Specialty OB Occupied:	____
Specialty OB Unoccupied:	____
Specialty NICU Occupied:	____
Specialty NICU Unoccupied:	____
Specialty NICU 4 Occupied:	____
Specialty NICU 4 Unoccupied:	____
Specialty NICU 3 Plus Occupied:	____
Specialty NICU 3 Plus Unoccupied:	____
Specialty NICU 3 Occupied:	____
Specialty NICU 3 Unoccupied:	____
Specialty NICU 2 Occupied:	____
Specialty NICU 2 Unoccupied:	____
Specialty Nursery Occupied:	____
Specialty Nursery Unoccupied:	____
Specialty NICU 1 Occupied:	____
Specialty NICU 1 Unoccupied:	____
Specialty Adult Psych Occupied:	____
Specialty Adult Psych Unoccupied:	____
Specialty Peds Psych Occupied:	____
Specialty Peds Psych Unoccupied:	____
Specialty Rehab Occupied:	____
Specialty Rehab Unoccupied:	____
Surge Beds
Surge Total Active Occupied:	____
Surge Total Active Unoccupied:	____
Surge Total Inactive Unoccupied:	____
Surge ICU Active Occupied:	____
Surge ICU Active Unoccupied:	____
Surge ICU Inactive Unoccupied:	____
Surge Non-ICU Active Occupied:	____
Surge Non-ICU Active Unoccupied:	____
Surge Non-ICU Inactive Unoccupied:	____
Emergency Department Beds
Adult ED Total Occupied:	____
Adult ED Total Admitted:	____
Peds ED Total Occupied:	____
Peds ED Total Admitted:	____
ED Total Occupied:	____
ED Total Admitted:	____
Additional Beds
Burn Occupied:	____
Burn Unoccupied:	____
Neg Pressure Occupied:	____
Neg Pressure Unoccupied:	____

Assurance of Confidentiality: The voluntarily provided information obtained in this surveillance system that would permit identification of any individual or institution is collected with a guarantee that it will be held in strict confidence, will be used only for the purposes stated, and will not otherwise be disclosed or released without the consent of the individual, or the institution in accordance with Sections 304, 306 and 308(d) of the Public Health Service Act (42 USC 242b, 242k, and 242m(d).

Public reporting burden of this collection of information is estimated to average 20 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering, and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC, Reports Clearance Officer, 1600 Clifton Rd., MS H21-8, Atlanta, GA 30333, ATTN: PRA (0920-0666).