OMB control number
Survey of Healthcare-Associated Infections and Antimicrobial Use in U.S. Nursing Homes for use in Exploring the Development of a National Prevalence Model
OMB 0920-1165 ยท HHS/CDC.
OMB 0920-1165
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Residents by Location Form | Form and Instruction |
| Healthcare Facility Assessment | Form and Instruction |
| Att. H - Information for NHs.docx | Supplementary Document |
| Att. F2 - Supplemental Resident Antimicrobial Use Form.docx | Supplementary Document |
| Att. F1 - Supplemental_Resident Infection Form.docx | Supplementary Document |
 Att. E - Instructions Residents by Location Form.doc | Supplementary Document |
| Att. C2 - Supplemental_Healthcare Facility Assessment Variables_EIP.docx | Supplementary Document |
 Att. G -- Non-research determination.pdf | Supplementary Document |
| HAI nursing home ICR_SuppStateA_OMB_r2.docx | Supporting Statement A |
| Att. B - 60-day FRN.pdf | Supplementary Document |
| Att. A - Section 301 of the Public Health Service Act (42 USC 241).pdf | Supplementary Document |
| HAI nursing home ICR_SuppStateB_OMB_r1.docx | Supporting Statement B |
 Residents by Location Form |
Form and Instruction |
| Healthcare Facility Assessment |
Form and Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 201605-0920-012 | New collection (Request for a new OMB Control Number) | 2016-06-03 | Approved with change |