OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

[NCEZID] The National Healthcare Safety Network (NHSN)

ICR 202502-0920-016 · 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 57.803 All Hazards Form and Instruction Unchanged Repair queued
Form 57.803 All Hazards Form and Instruction Unchanged Missing upstream
Form 57.802 Bed Capacity-IT Initial Set Up Form and Instruction Unchanged Available
Form 57.802 Bed Capacity-IT Initial Set Up Form and Instruction Unchanged Repair queued
Form 57.801 External Validation Summary Report Form and Instruction Unchanged Available
Form 57.801 External Validation Summary Report Form and Instruction Unchanged Repair queued
Form 57.215 Seasonal Survey on Influenza Vaccination Programs for Healthcare Personnel Form and Instruction Unchanged Available
Form 57.215 Seasonal Survey on Influenza Vaccination Programs for Healthcare Personnel Form and Instruction Unchanged Repair queued
Form 57.214 Annual Healthcare Personnel Influenza Vaccination Summary (CSV) Form Unchanged Repair queued
Form 57.214 Annual Healthcare Personnel Influenza Vaccination Summary (CSV) Form Unchanged Repair queued
Form 57.211 Weekly Healthcare Personnel Influenza Vaccination Cumulative Summary for Non-Long-Term Care Facilities (CSV) Form Unchanged Available
Form 57.211 Weekly Healthcare Personnel Influenza Vaccination Cumulative Summary for Non-Long-Term Care Facilities (CSV) Form Unchanged Repair queued
Form 57.133 Patient Safety Attestation Form and Instruction Unchanged Available
Form 57.133 Patient Safety Attestation Form and Instruction Unchanged Repair queued
Form 57.130 57.130 Pathogens of High Consequence Form and Instruction Unchanged Available
Form 57.130 57.130 Pathogens of High Consequence Form and Instruction Unchanged Missing upstream
Form 57.124 AUR Pharmacy Data Electronic Upload Specification Tables (Yearly Maintenance) Form Unchanged Available
Form 57.124 AUR Pharmacy Data Electronic Upload Specification Tables (Yearly Maintenance) Form Unchanged Repair queued
Form 57.124 AUR Pharmacy Data Electronic Upload Specification Tables (Initial Set-up) Form Unchanged Available
Form 57.124 AUR Pharmacy Data Electronic Upload Specification Tables (Initial Set-up) Form Unchanged Repair queued
Form 57.123 AUR Microbiolgy Data Electronic Upload Specification Tables (Yearly Maintenance) Form Unchanged Available
Form 57.123 AUR Microbiolgy Data Electronic Upload Specification Tables (Yearly Maintenance) Form Unchanged Repair queued
Form 57.123 AUR Microbiology Data Electronic Upload Specification Tables (Initial Set-up) Form Unchanged Available
Form 57.123 AUR Microbiology Data Electronic Upload Specification Tables (Initial Set-up) Form Unchanged Repair queued
Form 57.102 NHSN Help Desk Customer Satisfaction Survey Form and Instruction Unchanged Available
Form 57.102 NHSN Help Desk Customer Satisfaction Survey Form and Instruction Unchanged Repair queued
Form CDC 57.302 Hemovigilance Module Monthly Incident Summary Form and Instruction Unchanged Available
Form CDC 57.302 Hemovigilance Module Monthly Incident Summary Form and Instruction Unchanged Missing upstream
Form 57.800 Billing Code Data: 837I Upload Form Modified Available
Form 57.800 Billing Code Data: 837I Upload Form Modified Missing upstream
Form 57.701 57.701 - Glycemic Control Module-HYPO Annual Survey Form and Instruction Modified Repair queued
Form 57.701 57.701 - Glycemic Control Module-HYPO Annual Survey Form and Instruction Modified Missing upstream
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-Infection Preventionist Form and Instruction Unchanged Missing upstream
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 Available
Form 57.600 57.600 - Neonatal Component FHIR Measure-Late Onset Sepsis Meningitis (LOSMEN) Module-Infection Preventionist Form and Instruction Unchanged Missing upstream
Form 57.600 57.600 - Neonatal Component FHIR Measure-Late Onset Sepsis Meningitis (LOSMEN) Module-IT Yearly Maintenance Form and Instruction Unchanged Available
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 Initial Set up Form and Instruction Unchanged Available
Form 57.600 57.600 - Neonatal Component FHIR Measure-Late Onset Sepsis Meningitis (LOSMEN) Module-IT Initial Set up Form and Instruction Unchanged Missing upstream
Form 57.145 57.145 - Long Term Care Antimicrobial Use (LTC-AU) Module CDA Form and Instruction Modified Available
Form 57.145 57.145 - Long Term Care Antimicrobial Use (LTC-AU) Module CDA Form and Instruction Modified Repair queued
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 Digital Reporting Plan (RPS CSV) Form and Instruction Unchanged Available
Form 57.132 57.132 - Patient Safety Digital Reporting Plan (RPS CSV) Form and Instruction Unchanged Repair queued
Form 57.408 Monthly Survey Patient Days & Nurse Staffing Form and Instruction Unchanged Available
Form 57.408 Monthly Survey Patient Days & Nurse Staffing Form and Instruction Unchanged Repair queued
Form CDC 57.214 Annual Healthcare Personnel Influenza Vaccination Summary (manual) Form and Instruction Unchanged Available
Form CDC 57.214 Annual Healthcare Personnel Influenza Vaccination Summary (manual) Form and Instruction Unchanged Repair queued
Form CDC 57.211 Weekly Healthcare Personnel Influenza Vaccination Cumulative Summary for Non-Long-Term Care Facilities Form and Instruction Unchanged Repair queued
Form CDC 57.211 Weekly Healthcare Personnel Influenza Vaccination Cumulative Summary for Non-Long-Term Care Facilities Form and Instruction Unchanged Missing upstream
Form 57.601 Late Onset Sepsis/Meningitis Denominator Form: Data Table (Monthly) Form and Instruction Modified Available
Form 57.601 Late Onset Sepsis/Meningitis Denominator Form: Data Table (Monthly) Form and Instruction Modified Repair queued
Form 57.602 Long Term Care Facility Component - Respiratory Tract Infection Form and Instruction Modified Repair queued
Form 57.602 Long Term Care Facility Component - Respiratory Tract Infection Form and Instruction Modified Repair queued
57.104 NHSN Administrator Change Request Form Form and Instruction Unchanged Repair queued
57.104 NHSN Administrator Change Request Form Form and Instruction Unchanged Repair queued
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 Repair queued
Form CDC 57.405 57.405 Outpatient Procedure Component - Surgical Site Infection (SSI) Event Form Modified Available
Form CDC 57.405 57.405 Outpatient Procedure Component - Surgical Site Infection (SSI) Event Form Modified Repair queued
Form 57.404 57.404 Outpatient Procedure Component - SSI Denominators Form Modified Available
Form 57.404 57.404 Outpatient Procedure Component - SSI Denominators Form Modified Repair queued
Form 57.507 57.507 Home Dialysis Center Practices Survey Form Unchanged Available
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 Modified Available
Form 57.320 57.320 Hemovigilance Adverse Reaction - Other Transfusion Reaction Form Modified Missing upstream
Form CDC 57.319 57.319 Hemovigilance Adverse Reaction - Unknown Transfusion Reaction Form Modified Repair queued
Form CDC 57.319 57.319 Hemovigilance Adverse Reaction - Unknown Transfusion Reaction Form Modified 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 Modified Available
Form 57.317 57.317 Hemovigilance Adverse Reaction - Transfusion Associated Acute Lung Injury Form Modified Repair queued
Form CDC 57.316 57.316 Hemovigilance Adverse Reaction - Transfusion Associated Graft vs. Host Disease Form Modified Available
Form CDC 57.316 57.316 Hemovigilance Adverse Reaction - Transfusion Associated Graft vs. Host Disease Form Modified Repair queued
Form CDC 57.315 57.315 Hemovigilance Adverse Reaction - Transfusion Associated Dyspnea Form Modified Available
Form CDC 57.315 57.315 Hemovigilance Adverse Reaction - Transfusion Associated Dyspnea Form Modified Missing upstream
Form 57.314 57.314 Hemovigilance Adverse Reaction - Post Transfusion Purpura Form Modified Available
Form 57.314 57.314 Hemovigilance Adverse Reaction - Post Transfusion Purpura Form Modified Repair queued
Form 57.313 57.313 Hemovigilance Adverse Reaction - Infection Form Modified Available
Form 57.313 57.313 Hemovigilance Adverse Reaction - Infection Form Modified Repair queued
Form 57.312 57.312 Hemovigilance Adverse Reaction - Hypotensive Transfusion Reaction Form Modified Available
Form 57.312 57.312 Hemovigilance Adverse Reaction - Hypotensive Transfusion Reaction Form Modified Repair queued
Form CDC 57.311 57.311 Hemovigilance Adverse Reaction - Febrile Non-hemolytic Transfusion Reaction Form Modified Available
Form CDC 57.311 57.311 Hemovigilance Adverse Reaction - Febrile Non-hemolytic Transfusion Reaction Form Modified Repair queued
Form 57.310 57.310 Hemovigilance Adverse Reaction - Delayed Serologic Transfusion Reaction Form Modified Repair queued
Form 57.310 57.310 Hemovigilance Adverse Reaction - Delayed Serologic Transfusion Reaction Form Modified Repair queued
Form CDC 57.309 57.309 Hemovigilance Adverse Reaction - Delayed Hemolytic Transfusion Reaction Form Modified Available
Form CDC 57.309 57.309 Hemovigilance Adverse Reaction - Delayed Hemolytic Transfusion Reaction Form Modified Missing upstream
Form 57.308 57.308 Hemovigilance Adverse Reaction - Allergic Transfusion Reaction Form Modified Available
Form 57.308 57.308 Hemovigilance Adverse Reaction - Allergic Transfusion Reaction Form Modified Repair queued
Form 57.307 57.307 Hemovigilance Adverse Reaction - Acute Hemolytic Transfusion Reaction Form Modified Available
Form 57.307 57.307 Hemovigilance Adverse Reaction - Acute Hemolytic Transfusion Reaction Form Modified Repair queued
Form 57.306 57.306 Hemovigilance Module Annual Facility Survey - Non-acute Care Facility Form Modified Available
Form 57.306 57.306 Hemovigilance Module Annual Facility Survey - Non-acute Care Facility Form Modified Repair queued
Form 57.129 57.129_Adult Sepsis Form Modified Available
Form 57.129 57.129_Adult Sepsis Form Modified Repair queued
Form CDC 57.115 57.115 Custom Event Form Modified Repair queued
Form CDC 57.115 57.115 Custom Event Form Modified Repair queued
Form 57.113 57.113 Pediatric Ventilator-Associated Event (PedVAE) Form and Instruction Modified Available
Form 57.113 57.113 Pediatric Ventilator-Associated Event (PedVAE) Form and Instruction Modified 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 Available
Form CDC 57.501 57.501 Dialysis Monthly Reporting Plan Form Unchanged Repair queued
Form CDC 57.403 57.403 Outpatient Procedure Component - Monthly Denominators and Summary Form Unchanged Available
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 Modified Available
Form CDC 57.402 57.402 Outpatient Procedure Component Event Form Modified 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 Repair queued
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 Available
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 Missing upstream
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 Unchanged Repair queued
Form CDC 57.142 57.142 Denominators for LTCF Locations Form Unchanged Repair queued
Form CDC 57.141 57.141 Monthly Reporting Plan for LTCF Form Unchanged Available
Form CDC 57.141 57.141 Monthly Reporting Plan for LTCF Form Unchanged Repair queued
Form 57.112 57.112 Ventilator-Associated Event (VAE) Form and Instruction Modified Available
Form 57.112 57.112 Ventilator-Associated Event (VAE) Form and Instruction Modified Repair queued
Form CDC 57.139 57.139 MDRO and CDI Prevention Process Measures Monthly for LTCF Form Unchanged Available
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 Modified Available
Form CDC 57.138 57.138 Laboratory-Identified MDRO or CDI Event for LTCF Form Modified Repair queued
Form CDC 57.137 57.137 Long Term care Facility Component--Annual Facility Survey Form Unchanged Repair queued
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 Available
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 Repair queued
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 Available
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 Modified Available
Form CDC 57.300 57.300 Hemovigilance Module Annual Survey -- Acute Care Facility Form Modified 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 Missing upstream
Form 57.140 57.140 Urinary Tract Infection (UTI) for LTCF Form and Instruction Modified Available
Form 57.140 57.140 Urinary Tract Infection (UTI) for LTCF Form and Instruction Modified 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 Repair queued
Form CDC 57.101 57.101 Facility Contact Information Form Unchanged Repair queued
Form 57.124 57.124 Antimicrobial Use and Resistence (AUR) - Pharmacy Data Form and Instruction Unchanged Available
Form 57.124 57.124 Antimicrobial Use and Resistence (AUR) - Pharmacy Data Form and Instruction Unchanged Repair queued
Form 57.123 57.123 Antimicrobial Use and Resistance (AUR) - Microbiology Data Upload Tables Form and Instruction Modified Repair queued
Form 57.123 57.123 Antimicrobial Use and Resistance (AUR) - Microbiology Data Upload Tables Form and Instruction Modified Repair queued
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 Modified Repair queued
Form 57.121 57.121 Denominators for Procedure Form and Instruction Modified Repair queued
Form 57.128 57.128 Laboratory Identified or CDI MDRO Event Form Modified Available
Form 57.128 57.128 Laboratory Identified or CDI MDRO Event Form Modified Missing upstream
Form CDC 57.120 57.120 Surgical Site Infection (SSI) Form Modified Available
Form CDC 57.120 57.120 Surgical Site Infection (SSI) Form Modified Missing upstream
Form CDC 57.126 57.126 MDRO or CDI Infection Event Form Modified Available
Form CDC 57.126 57.126 MDRO or CDI Infection Event Form Modified Repair queued
Form CDC 57.503 57.503 Denominators for Outpatient Dialysis Form Unchanged Available
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 Available
Form CDC 57.118 57.118 Denominators for Intensive Care Unit (ICU) Other Locations (Not NICU or SCA) Form Unchanged Repair queued
Form CDC 57.117 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 Modified Repair queued
Form CDC 57.125 57.125 Central Line Insertion Practices Adherence Monitoring Form Form Modified 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 Modified Available
Form 57.114 57.114 Urinary Tract Infection (UTI) Form and Instruction Modified Repair queued
Form 57.111 57.111 Pneumonia (includes Any Patient Pneumonia flow Diagram and Infant and Children Pneumonia Flow Diagram) Form and Instruction Modified Available
Form 57.111 57.111 Pneumonia (includes Any Patient Pneumonia flow Diagram and Infant and Children Pneumonia Flow Diagram) Form and Instruction Modified Repair queued
Form CDC 57.502 57.502 Dialysis Event Form and Instruction Modified Available
Form CDC 57.502 57.502 Dialysis Event Form and Instruction Modified Repair queued
Form 57.108 57.108 Primary Bloodstream Infection (BSI) Form and Instruction Modified Repair queued
Form 57.108 57.108 Primary Bloodstream Infection (BSI) Form and Instruction Modified Repair queued
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
Change Request Memo - EO14168.docx Justification for No Material/Nonsubstantive Change Uploaded 2025-03-05 Available
Change Request Memo - EO14168.docx Justification for No Material/Nonsubstantive Change Uploaded 2025-03-05 Repair queued
Emergency Request Memo_23DEC2024.docx Supplementary Document Uploaded 2024-12-23 Available
Emergency Request Memo_23DEC2024.docx Supplementary Document Uploaded 2024-12-23 Repair queued
G3. Privacy Impact Assessment_NHSN_PIA_Signed_2023-01-19.pdf Supplementary Document Uploaded 2024-12-23 Repair queued
G3. Privacy Impact Assessment_NHSN_PIA_Signed_2023-01-19.pdf Supplementary Document Uploaded 2024-12-23 Repair queued
Human Subject Determination-IRB approval.pdf Supplementary Document Uploaded 2024-12-23 Available
Human Subject Determination-IRB approval.pdf Supplementary Document Uploaded 2024-12-23 Repair queued
Copy of 2025 OMB FHIR RPS Data Dictionary_JAN_2025_UPDATES.xlsx Supplementary Document Uploaded 2025-03-05 Available
Copy of 2025 OMB FHIR RPS Data Dictionary_JAN_2025_UPDATES.xlsx Supplementary Document Uploaded 2025-03-05 Repair queued
Copy of 2025 OMB FHIR ACH Monthly Measures Data Dictionary_JAN_2025_UPDATES.xlsx Supplementary Document Uploaded 2025-03-05 Available
Copy of 2025 OMB FHIR ACH Monthly Measures Data Dictionary_JAN_2025_UPDATES.xlsx Supplementary Document Uploaded 2025-03-05 Repair queued
G3. Privacy Impact Assessment_NHSN_PIA_Signed_2023-01-19.pdf Supplementary Document Uploaded 2024-10-31 Repair queued
G3. Privacy Impact Assessment_NHSN_PIA_Signed_2023-01-19.pdf Supplementary Document Uploaded 2024-10-31 Repair queued
G2. Privacy Impact Assessment_ NHSN2-Cloud_PIA_Signed_2023-12-05_eRAP.pdf Supplementary Document Uploaded 2024-10-31 Available
G2. Privacy Impact Assessment_ NHSN2-Cloud_PIA_Signed_2023-12-05_eRAP.pdf Supplementary Document Uploaded 2024-10-31 Repair queued
G1. Privacy Impact Assessment.pdf Supplementary Document Uploaded 2024-10-31 Available
G1. Privacy Impact Assessment.pdf Supplementary Document Uploaded 2024-10-31 Repair queued
F2. NHSN 308d Request for Extension and Ammendment.docx Supplementary Document Uploaded 2024-10-31 Available
F2. NHSN 308d Request for Extension and Ammendment.docx Supplementary Document Uploaded 2024-10-31 Repair queued
F1. NHSN 308d Approval 2015.pdf Supplementary Document Uploaded 2024-10-31 Available
F1. NHSN 308d Approval 2015.pdf Supplementary Document Uploaded 2024-10-31 Repair queued
E3. Human Subjects Determination_2.pdf Supplementary Document Uploaded 2024-10-31 Repair queued
E3. Human Subjects Determination_2.pdf Supplementary Document Uploaded 2024-10-31 Repair queued
E2. Report of End of Human Research Review 0.1253.docx Supplementary Document Uploaded 2024-10-31 Available
E2. Report of End of Human Research Review 0.1253.docx Supplementary Document Uploaded 2024-10-31 Repair queued
E1. Closure CDC Protocol # 4062.docx Supplementary Document Uploaded 2024-10-31 Available
E1. Closure CDC Protocol # 4062.docx Supplementary Document Uploaded 2024-10-31 Missing upstream
D2. Explanation for Program Changes or Adjustments 2024-0920-0666.docx Supplementary Document Uploaded 2024-10-31 Available
D2. Explanation for Program Changes or Adjustments 2024-0920-0666.docx Supplementary Document Uploaded 2024-10-31 Repair queued
D1. Explanation for Program Changes or Adjustments 2024-0920-0666_v2.docx Supplementary Document Uploaded 2024-10-31 Available
D1. Explanation for Program Changes or Adjustments 2024-0920-0666_v2.docx Supplementary Document Uploaded 2024-10-31 Repair queued
B. 60-Day Published Federal Register Notice.pdf Supplementary Document Uploaded 2024-10-30 Available
B. 60-Day Published Federal Register Notice.pdf Supplementary Document Uploaded 2024-10-30 Repair queued
A3. 42 USC 242m.pdf Supplementary Document Uploaded 2024-10-30 Repair queued
A3. 42 USC 242m.pdf Supplementary Document Uploaded 2024-10-30 Repair queued
A2. 42 USC 242k.pdf Supplementary Document Uploaded 2024-10-30 Repair queued
A2. 42 USC 242k.pdf Supplementary Document Uploaded 2024-10-30 Repair queued
A1. 42 USC 242b.pdf Supplementary Document Uploaded 2024-10-30 Available
A1. 42 USC 242b.pdf Supplementary Document Uploaded 2024-10-30 Repair queued
Supporting Statement B.docx Supporting Statement B Uploaded 2024-12-23 Available
Supporting Statement B.docx Supporting Statement B Uploaded 2024-12-23 Repair queued
Supporting Statement A.docx Supporting Statement A Uploaded 2024-12-23 Available
Supporting Statement A.docx Supporting Statement A Uploaded 2024-12-23 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
272124 All Hazards Form and Instruction Unchanged
272124 All Hazards Form and Instruction Unchanged
272123 Bed Capacity-IT Initial Set Up Form and Instruction Unchanged
272123 Bed Capacity-IT Initial Set Up Form and Instruction Unchanged
272122 External Validation Summary Report Form and Instruction Unchanged
272122 External Validation Summary Report Form and Instruction Unchanged
272108 Seasonal Survey on Influenza Vaccination Programs for Healthcare Personnel Form and Instruction Unchanged
272108 Seasonal Survey on Influenza Vaccination Programs for Healthcare Personnel Form and Instruction Unchanged
272105 Annual Healthcare Personnel Influenza Vaccination Summary (CSV) Form Unchanged
272105 Annual Healthcare Personnel Influenza Vaccination Summary (CSV) Form Unchanged
272101 Weekly Healthcare Personnel Influenza Vaccination Cumulative Summary for Non-Long-Term Care Facilities (CSV) Form Unchanged
272101 Weekly Healthcare Personnel Influenza Vaccination Cumulative Summary for Non-Long-Term Care Facilities (CSV) Form Unchanged
272031 Patient Safety Attestation Form and Instruction Unchanged
272031 Patient Safety Attestation Form and Instruction Unchanged
272029 57.130 Pathogens of High Consequence Form and Instruction Unchanged
272029 57.130 Pathogens of High Consequence Form and Instruction Unchanged
272027 AUR Pharmacy Data Electronic Upload Specification Tables (Yearly Maintenance) Form Unchanged
272027 AUR Pharmacy Data Electronic Upload Specification Tables (Yearly Maintenance) Form Unchanged
272026 AUR Pharmacy Data Electronic Upload Specification Tables (Initial Set-up) Form Unchanged
272026 AUR Pharmacy Data Electronic Upload Specification Tables (Initial Set-up) Form Unchanged
272025 AUR Microbiolgy Data Electronic Upload Specification Tables (Yearly Maintenance) Form Unchanged
272025 AUR Microbiolgy Data Electronic Upload Specification Tables (Yearly Maintenance) Form Unchanged
272024 AUR Microbiology Data Electronic Upload Specification Tables (Initial Set-up) Form Unchanged
272024 AUR Microbiology Data Electronic Upload Specification Tables (Initial Set-up) Form Unchanged
272017 NHSN Help Desk Customer Satisfaction Survey Form and Instruction Unchanged
272017 NHSN Help Desk Customer Satisfaction Survey Form and Instruction Unchanged
265665 Hemovigilance Module Monthly Incident Summary Form and Instruction Unchanged
265665 Hemovigilance Module Monthly Incident Summary Form and Instruction Unchanged
263469 Billing Code Data: 837I Upload Form Modified
263469 Billing Code Data: 837I Upload Form Modified
263468 57.701 - Glycemic Control Module-HYPO Annual Survey Form and Instruction Modified
263468 57.701 - Glycemic Control Module-HYPO Annual Survey Form and Instruction Modified
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 Modified
263460 57.145 - Long Term Care Antimicrobial Use (LTC-AU) Module CDA Form and Instruction Modified
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 Other-OMB Header and Burden Statement Unchanged
263450 57.132 - Patient Safety Component FHIR Measures-HOB, HT-CDI Modules-IT Initial Set up Other-OMB Header and Burden Statement Unchanged
263449 57.132 - Patient Safety Digital Reporting Plan (RPS CSV) Form and Instruction Unchanged
263449 57.132 - Patient Safety Digital Reporting Plan (RPS CSV) 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 (manual) Form and Instruction Unchanged
246758 Annual Healthcare Personnel Influenza Vaccination Summary (manual) 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 Late Onset Sepsis/Meningitis Denominator Form: Data Table (Monthly) Form and Instruction Modified
244476 Late Onset Sepsis/Meningitis Denominator Form: Data Table (Monthly) Form and Instruction Modified
238093 Long Term Care Facility Component - Respiratory Tract Infection Form and Instruction Modified
238093 Long Term Care Facility Component - Respiratory Tract Infection Form and Instruction Modified
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 Modified
228154 57.405 Outpatient Procedure Component - Surgical Site Infection (SSI) Event Form Modified
228153 57.404 Outpatient Procedure Component - SSI Denominators Form Modified
228153 57.404 Outpatient Procedure Component - SSI Denominators Form Modified
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 Modified
222907 57.320 Hemovigilance Adverse Reaction - Other Transfusion Reaction Form Modified
222906 57.319 Hemovigilance Adverse Reaction - Unknown Transfusion Reaction Form Modified
222906 57.319 Hemovigilance Adverse Reaction - Unknown Transfusion Reaction Form Modified
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 Modified
222904 57.317 Hemovigilance Adverse Reaction - Transfusion Associated Acute Lung Injury Form Modified
222903 57.316 Hemovigilance Adverse Reaction - Transfusion Associated Graft vs. Host Disease Form Modified
222903 57.316 Hemovigilance Adverse Reaction - Transfusion Associated Graft vs. Host Disease Form Modified
222902 57.315 Hemovigilance Adverse Reaction - Transfusion Associated Dyspnea Form Modified
222902 57.315 Hemovigilance Adverse Reaction - Transfusion Associated Dyspnea Form Modified
222901 57.314 Hemovigilance Adverse Reaction - Post Transfusion Purpura Form Modified
222901 57.314 Hemovigilance Adverse Reaction - Post Transfusion Purpura Form Modified
222900 57.313 Hemovigilance Adverse Reaction - Infection Form Modified
222900 57.313 Hemovigilance Adverse Reaction - Infection Form Modified
222899 57.312 Hemovigilance Adverse Reaction - Hypotensive Transfusion Reaction Form Modified
222899 57.312 Hemovigilance Adverse Reaction - Hypotensive Transfusion Reaction Form Modified
222898 57.311 Hemovigilance Adverse Reaction - Febrile Non-hemolytic Transfusion Reaction Form Modified
222898 57.311 Hemovigilance Adverse Reaction - Febrile Non-hemolytic Transfusion Reaction Form Modified
222897 57.310 Hemovigilance Adverse Reaction - Delayed Serologic Transfusion Reaction Form Modified
222897 57.310 Hemovigilance Adverse Reaction - Delayed Serologic Transfusion Reaction Form Modified
222896 57.309 Hemovigilance Adverse Reaction - Delayed Hemolytic Transfusion Reaction Form Modified
222896 57.309 Hemovigilance Adverse Reaction - Delayed Hemolytic Transfusion Reaction Form Modified
222895 57.308 Hemovigilance Adverse Reaction - Allergic Transfusion Reaction Form Modified
222895 57.308 Hemovigilance Adverse Reaction - Allergic Transfusion Reaction Form Modified
222894 57.307 Hemovigilance Adverse Reaction - Acute Hemolytic Transfusion Reaction Form Modified
222894 57.307 Hemovigilance Adverse Reaction - Acute Hemolytic Transfusion Reaction Form Modified
222893 57.306 Hemovigilance Module Annual Facility Survey - Non-acute Care Facility Form Modified
222893 57.306 Hemovigilance Module Annual Facility Survey - Non-acute Care Facility Form Modified
222892 57.129_Adult Sepsis Form Modified
222892 57.129_Adult Sepsis Form Modified
222891 57.115 Custom Event Form Modified
222891 57.115 Custom Event Form Modified
222890 57.113 Pediatric Ventilator-Associated Event (PedVAE) Form and Instruction Modified
222890 57.113 Pediatric Ventilator-Associated Event (PedVAE) Form and Instruction Modified
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 Modified
208406 57.402 Outpatient Procedure Component Event Form Modified
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 Unchanged
200379 57.142 Denominators for LTCF Locations Form Unchanged
200378 57.141 Monthly Reporting Plan for LTCF Form Unchanged
200378 57.141 Monthly Reporting Plan for LTCF Form Unchanged
200377 57.112 Ventilator-Associated Event (VAE) Form and Instruction Modified
200377 57.112 Ventilator-Associated Event (VAE) Form and Instruction Modified
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 Modified
197542 57.138 Laboratory-Identified MDRO or CDI Event for LTCF Form Modified
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 Modified
190360 57.300 Hemovigilance Module Annual Survey -- Acute Care Facility Form Modified
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 Modified
183573 57.140 Urinary Tract Infection (UTI) for LTCF Form and Instruction Modified
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 Modified
183566 57.123 Antimicrobial Use and Resistance (AUR) - Microbiology Data Upload Tables Form and Instruction Modified
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 Modified
183564 57.121 Denominators for Procedure Form and Instruction Modified
183563 57.128 Laboratory Identified or CDI MDRO Event Form Modified
183563 57.128 Laboratory Identified or CDI MDRO Event Form Modified
183562 57.120 Surgical Site Infection (SSI) Form Modified
183562 57.120 Surgical Site Infection (SSI) Form Modified
183561 57.126 MDRO or CDI Infection Event Form Modified
183561 57.126 MDRO or CDI Infection Event Form Modified
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
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 Modified
183555 57.125 Central Line Insertion Practices Adherence Monitoring Form Form Modified
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 Modified
183551 57.114 Urinary Tract Infection (UTI) Form and Instruction Modified
183549 57.111 Pneumonia (includes Any Patient Pneumonia flow Diagram and Infant and Children Pneumonia Flow Diagram) Form and Instruction Modified
183549 57.111 Pneumonia (includes Any Patient Pneumonia flow Diagram and Infant and Children Pneumonia Flow Diagram) Form and Instruction Modified
183547 57.502 Dialysis Event Form and Instruction Modified
183547 57.502 Dialysis Event Form and Instruction Modified
183545 57.108 Primary Bloodstream Infection (BSI) Form and Instruction Modified
183545 57.108 Primary Bloodstream Infection (BSI) Form and Instruction Modified
183544 57.500 Outpatient Dialysis Center Practices Survey Form and Instruction Unchanged
183544 57.500 Outpatient Dialysis Center Practices Survey Form and Instruction 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 No202412-0920-019
Agency Tracking No0920-25-0029
Date Submitted to OIRA2025-03-28
Requested Expiration Date2024-12-31