[NCEZID] National Healthcare Safety Network (NHSN) Coronavirus (COVID-19) Surveillance in Healthcare Facilities

ICR 202502-0920-015

OMB: 0920-1317

Federal Form Document

Forms and Documents

Document Name	Status
Form 57.510 57.510 COVID–19 Module Dialysis Outpatient Facility-CSV Form and Instruction	Unchanged
Form 57.509 57.509 Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities-.CSV Form and Instruction	Unchanged
Form 57.221 57.221 Healthcare Personnel COVID-19 Person Level Vaccination-Healthcare Personnel Safety Component_CSV Form and Instruction	Removed
Form 57.221 57.221 Healthcare Personnel COVID-19 Person Level Vaccination-Healthcare Personnel Safety Component_Manual Form and Instruction	Removed
Form 57.221 57.221 Healthcare Personnel COVID-19 Person Level Vaccination-LTC Component_CSV Form and Instruction	Removed
Form 57.221 57.221 Healthcare Personnel COVID-19 Person Level Vaccination-LTC Component _Manual Form and Instruction	Removed
Form 57.220 57.220 Weekly Person Level Respiratory Pathogen and Vaccination for Residents-LTCF Component_CSV Form and Instruction	Removed
Form 57.220 57.220 Weekly Person Level Respiratory Pathogen and Vaccination for Residents-LTCF Component_Manual Form and Instruction	Removed
Form 57.155 57.155 Point of Care Testing Results - CSV Form and Instruction	Modified
Form 57.219 Weekly Healthcare Personnel COVID-19 Vaccination Cumulative Summary (.csv) Form and Instruction	Unchanged
Form 57.218 Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities (.csv) Form and Instruction	Unchanged
Form 57.217 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel (.csv) Form and Instruction	Modified
Form 57.217 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel (manual) Form and Instruction	Modified
Form 57.216 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents (.csv) Form and Instruction	Modified
Form 57.216 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents (manual) Form and Instruction	Modified
Form 57.102 57.102 - Hospital Respiratory Data Fomr (Daily - API) Form and Instruction	Unchanged
Form 57.102 57.102 Hospital Respiratory Data Form (Daily - .csv import) Form and Instruction	Unchanged
Form 57.102 57.102 - Hospital Respiratory Data Form (Daily - user entry) Form and Instruction	Unchanged
Form 0920-1317 57.101 Hospital Respiratory Data Form (Weekly - API) Form and Instruction	Unchanged
Form 0920-1317 57.101 Hospital Respiratory Data Form (Weekly - .csv import) Form and Instruction	Unchanged
Form 0920-1317 57.101 Hospital Respiratory Data Form (Weekly - User Entry) Form and Instruction	Unchanged
Form 57.155 57.155 Point of Care Testing Results - Manual Form and Instruction	Modified
Form 57.509 57.509 Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities_Manual Form and Instruction	Unchanged
Form Form 57.218 Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities (manual) Form and Instruction	Unchanged
Form 57.219 Weekly Healthcare Personnel COVID-19 Vaccination Cumulative Summary (manual) Form and Instruction	Unchanged
Form 57.510 57.510 COVID–19 Module Dialysis Outpatient Facility_Manual Form and Instruction	Unchanged
Form 0920-1317 57.140 NHSN and Secure Access Management Services (SAMS) enrollment Form and Instruction	Unchanged
Change Request Memo - EO14168.docx Justification for No Material/Nonsubstantive Change	2025-03-04
Change Memo 0920-1317 December 2024.docx Justification for No Material/Nonsubstantive Change	2025-01-09
D. Explanation for Program Changes or Adjustments.docx Supplementary Document	2024-10-29
G2. Privacy Impact Assessment.pdf Supplementary Document	2024-10-29
G1. Privacy Impact Assessment.pdf Supplementary Document	2024-10-29
G. Privacy Impact Assessment.pdf Supplementary Document	2024-10-29
E3. Human Subjects Determination.pdf Supplementary Document	2024-10-29
B. FRN-60 day.pdf Supplementary Document	2024-10-29
SSB 0920-1317 NHSN COVID-19_FINAL.docx Supporting Statement B	2024-10-29
SSA 0920-1317 NHSN COVID 08JAN2025.docx Supporting Statement A	2025-03-04
Change Memo 0920-1317 August 2024_FINAL_v2.docx Justification for No Material/Nonsubstantive Change	2024-08-22
Change Memo 0920-1317.docx Justification for No Material/Nonsubstantive Change	2024-08-06
Change Request Memo NHSN COVID-19 0920-1317_26APR2024 v2.docx Justification for No Material/Nonsubstantive Change	2024-04-26
Change Memo for CDC NHSN COVID-19 OMB Package 0920-1317.docx Justification for No Material/Nonsubstantive Change	2024-03-14
Resident Impact and Facility Capacity- csv temp..csv Supplementary Document	2023-09-07
TOI-Facility Importing COVID-19 and Respiratory Infections using a .csv file_RIFC.docx Supplementary Document	2023-09-07
Change Memo for NHSN September 2023_0920_1317.docx Justification for No Material/Nonsubstantive Change	2023-09-07
Crosswalk_57.218.docx Supplementary Document	2023-09-07
Crosswalk_57.144.docx Supplementary Document	2023-09-07
Crosswalk-COVID-19 Hospital Data.docx Supplementary Document	2023-09-07
Crosswalk 11.4 updated COVID JUNE_final.docx Supplementary Document	2023-05-18
Change Memo for NHSN May 2023_0920_1317_final.docx Justification for No Material/Nonsubstantive Change	2023-05-18
CDC Response to APIC Dec29 letter sk lw.docx Supplementary Document	2023-03-06
5. NHSN - Report of End of Human Research Review 0.1253.docx Supplementary Document	2022-11-28
6. IRB Protocol Closure.pdf Supplementary Document	2022-11-28
3. Privacy Act Checklist 2022.docx Supplementary Document	2022-11-28
1c. 42 USC 242m.PDF Supplementary Document	2022-11-28
1b. 42 USC 242k.PDF Supplementary Document	2022-11-28
1a. 42 USC 242b.PDF Supplementary Document	2022-11-28

IC Document Collections

IC ID	Document Title	Status
271955	57.510 COVID–19 Module Dialysis Outpatient Facility-CSV Form and Instruction	Unchanged
271950	57.509 Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities-.CSV Form and Instruction	Unchanged
271948	57.221 Healthcare Personnel COVID-19 Person Level Vaccination-Healthcare Personnel Safety Component_CSV Form and Instruction	Removed
271947	57.221 Healthcare Personnel COVID-19 Person Level Vaccination-Healthcare Personnel Safety Component_Manual Form and Instruction	Removed
271946	57.221 Healthcare Personnel COVID-19 Person Level Vaccination-LTC Component_CSV Form and Instruction	Removed
271945	57.221 Healthcare Personnel COVID-19 Person Level Vaccination-LTC Component _Manual Form and Instruction	Removed
271943	57.220 Weekly Person Level Respiratory Pathogen and Vaccination for Residents-LTCF Component_CSV Form and Instruction	Removed
271941	57.220 Weekly Person Level Respiratory Pathogen and Vaccination for Residents-LTCF Component_Manual Form and Instruction	Removed
271935	57.155 Point of Care Testing Results - CSV Form and Instruction	Modified
270333	Weekly Healthcare Personnel COVID-19 Vaccination Cumulative Summary (.csv) Form and Instruction	Unchanged
270316	Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities (.csv) Form and Instruction	Unchanged
270313	Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel (.csv) Form and Instruction	Modified
270312	Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel (manual) Form and Instruction	Modified
270310	Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents (.csv) Form and Instruction	Modified
270309	Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents (manual) Form and Instruction	Modified
269868	57.102 - Hospital Respiratory Data Fomr (Daily - API) Form and Instruction	Unchanged
269867	57.102 Hospital Respiratory Data Form (Daily - .csv import) Form and Instruction	Unchanged
269866	57.102 - Hospital Respiratory Data Form (Daily - user entry) Form and Instruction	Unchanged
269865	57.101 Hospital Respiratory Data Form (Weekly - API) Form and Instruction	Unchanged
269864	57.101 Hospital Respiratory Data Form (Weekly - .csv import) Form and Instruction	Unchanged
269863	57.101 Hospital Respiratory Data Form (Weekly - User Entry) Form and Instruction	Unchanged
266012	57.155 Point of Care Testing Results - Manual Form and Instruction	Modified
249436	57.509 Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities_Manual Form and Instruction	Unchanged
249435	Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities (manual) Form and Instruction	Unchanged
249434	Weekly Healthcare Personnel COVID-19 Vaccination Cumulative Summary (manual) Form and Instruction	Unchanged
243719	57.510 COVID–19 Module Dialysis Outpatient Facility_Manual Form and Instruction	Unchanged
243698	57.140 NHSN and Secure Access Management Services (SAMS) enrollment Form and Instruction	Unchanged