Prevalence Survey of Healthcare Associated Infections (HAIs) and Antimicrobial Use in U.S. Acute Care Hospitals

OMB 0920-0852

Preventing healthcare-associated infections (HAIs) and improving antimicrobial use (AU) are CDC and national priorities. An extension of the prevalence survey’s existing OMB approval is sought to allow a repeat HAI and AU Prevalence Survey to be performed in 2020. A repeat survey will allow assessment of changes in HAI and AU prevalence, pathogen distribution, and quality of antimicrobial prescribing. These data will also allow CDC and its partners to continue to monitor HAI and AU trends, to measure progress in meeting national targets, and to further refine prevention strategies.

The latest form for Prevalence Survey of Healthcare Associated Infections (HAIs) and Antimicrobial Use in U.S. Acute Care Hospitals expires 2022-10-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Patient Information Form (PIF) Form
Healthcare Facility Assessment (HFA) Form
Att_I_d_AQUA UTI_Form_Aug22.docx Supplementary Document
Att_I_c_AQUA CAP_Form_Aug22.docx Supplementary Document
Att_I_b_AQUA Fluoroquinolone Form_Aug22.docx Supplementary Document
Att_I_a_AQUA Vancomycin Form_Aug22.docx Supplementary Document
Att_H_AQUA General Patient Assessment Form_Aug22.docx Supplementary Document
Att_G_AQUA Case Eligibility Form_Aug22.docx Supplementary Document
Att_E_HAI Form_Aug22.docx Supplementary Document
Att_C1_EIP HFA_Aug22.docx Supplementary Document
Change request_HPPS_HAI and AU_2023_08_02_2022.docx Justification for No Material/Nonsubstantive Change
Attachment_I_c_AQUA CAP_Form.docx Supplementary Document
HAIPS PTA Signed 2019.pdf Supplementary Document
Attachment_I_d_AQUA UTI_Form.docx Supplementary Document
Attachment_I_b_AQUA Fluoroquinolone Form.docx Supplementary Document
Attachment_M_Draft example of Informaton document distributed to HCF.pdf Supplementary Document
Attachment_L_ Non-research_Determination.pdf Supplementary Document
Attachment_K_NCHS_Consultation.pdf Supplementary Document
Attachment_J_HFA_PIF_Instructions.pdf Supplementary Document
Attachment_I_a_AQUA Vancomycin Form.docx Supplementary Document
Attachment_H_AQUA General Patient Assessment Form.docx Supplementary Document
Attachment_G_AQUA Case Eligibility Form.docx Supplementary Document
Attachment_F_AU Form.docx Supplementary Document
Attachment_E_HAI Form.docx Supplementary Document
Attachment_B_60-Day_0920-0852 Published Federal Register.pdf Supplementary Document
Attachment_A2_ARRA.pdf Supplementary Document
Attachment_A_Section 301 of the Public Health Service Act (42 USC 241).pdf Supplementary Document
SSB_0920_0852_Extension_2021_final.docx Supporting Statement B
SSA_0920_0852_Extension_2021_final_ICRO.docx Supporting Statement A
Patient Information Form (PIF) Form
Healthcare Facility Assessment (HFA) Form

All Historical Document Collections

202207-0920-011 Approved without change	No material or nonsubstantive change to a currently approved collection	2022-08-03
202112-0920-006 Approved without change	Extension without change of a currently approved collection	2021-12-27
201908-0920-006 Approved with change	Extension without change of a currently approved collection	2019-09-04
201612-0920-005 Approved without change	No material or nonsubstantive change to a currently approved collection	2016-12-08
201608-0920-019 Approved without change	Revision of a currently approved collection	2016-09-29
201407-0920-018 Approved without change	No material or nonsubstantive change to a currently approved collection	2014-08-08
201407-0920-009 Improperly submitted and continue	No material or nonsubstantive change to a currently approved collection	2014-07-22
201406-0920-008 Improperly submitted and continue	No material or nonsubstantive change to a currently approved collection	2014-06-20
201310-0920-002 Approved without change	Reinstatement with change of a previously approved collection	2013-10-21
201304-0920-003 Improperly submitted and continue	Extension without change of a currently approved collection	2013-04-03
201303-0920-004 Improperly submitted and continue	Extension without change of a currently approved collection	2013-03-08
201102-0920-010 Approved without change	No material or nonsubstantive change to a currently approved collection	2011-02-15
201004-0920-002 Approved with change	New collection (Request for a new OMB Control Number)	2010-04-05

OMB Details

Healthcare Facility Assessment (HFA)

Federal Enterprise Architecture: Health - Public Health Monitoring

Form none

Healthcare Facility Assessment

Paper Only

Form

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.