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

OMB 0920-1317

Latest Forms, Documents, and Supporting Material

Document Name
NHSN COVID-19 Hospital Module (Infusion Centers and Outpatient Clinics reporting Inventory & use of therapeutics (MABs) Form and Instruction
NHSN COVID-19 Hospital Module (Hospitals) Form and Instruction
Form CDC Form 57.203 Healthcare Personnel Safety Monthly Reporting Plan - completed by Inpatient Psychiatric Facilities Form and Instruction
Form CDC Form 57.203 Healthcare Personnel Safety Monthly Reporting Plan - completed by Dialysis Facilities Form and Instruction
Form CDC Form 57.141 Monthly Reporting Plan form for Long-term Care Facilities Form and Instruction
Form 0920-1317 / CDC Fo Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities Form and Instruction
Form 0920-1317 / CDC Fo Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities Form and Instruction
Form CDC Form 57.219 Weekly Healthcare Personnel COVID-19 Vaccination Cumulative Summary Form and Instruction
Form 0920-1317 VA - Staff and Personnel COVID-19 Event Form - LTCF Form and Instruction
Form 0920-1317 VA - Resident COVID-19 Event Form - LTCF Form and Instruction
Form 0920-1317 CDC 57.X Resident Therapeutics - State and Local Health Dept. Occupations Form and Instruction
Form 0920-1317 CDC 57.X Resident Therapeutics - Business and Financial Operations Occupations Form and Instruction
Form 0920-1317 CDC 57.X Resident Therapeutics - LTCF Personnel Form and Instruction
Dialysis Component Form and Instruction
Form CDC 57.145 Staff and Personnel Impact - State and Local Health Dept Occupations retrospective Form and Instruction
Form CDC 57.145 Staff and Personnel Impact - Business and Financial Operations Occupations retrospective Form and Instruction
Form CDC 57.145 Staff and Personnel Impact - LTCF Personnel retrospective Form and Instruction
Form CDC 57.145 Staff and Personnel Impact - State and Local Health Dept Occupations Form and Instruction
Form CDC 57.145 Staff and Personnel Impact - Business and Financial Operations Occupations Form and Instruction
Form CDC 57.145 Staff and Personnel Impact - LTCF Personnel Form and Instruction
Form CDC 57.144 Resident Impact and Facility Capacity - State and Local Health Dept Occupations retrospective Form and Instruction
Form CDC 57.144 Resident Impact and Facility Capacity - Business and Financial Operations Occupations retrospective Form and Instruction
Form CDC 57.144 Resident Impact and Facility Capacity - LTCF Personnel retrospective Form and Instruction
Form CDC 57.144 Resident Impact and Facility Capacity - LTCF Personnel, Business and Financial operations and State and Local Health Dept. Occupations Form and Instruction
Form 0920-1317 NHSN and Secure Access Management Services (SAMS) enrollment Form and Instruction
Crosswalk 11.4 updated COVID JUNE_final.docx Supplementary Document
Change Memo for NHSN May 2023_0920_1317_final.docx Justification for No Material/Nonsubstantive Change
CDC Response to APIC Dec29 letter sk lw.docx Supplementary Document
5. NHSN - Report of End of Human Research Review 0.1253.docx Supplementary Document
6. IRB Protocol Closure.pdf Supplementary Document
3. Privacy Act Checklist 2022.docx Supplementary Document
2. Published 60-day FRN.pdf Supplementary Document
1c. 42 USC 242m.PDF Supplementary Document
1b. 42 USC 242k.PDF Supplementary Document
1a. 42 USC 242b.PDF Supplementary Document
SSB 0920-1317 NHSN COVID-19 Module.docx Supporting Statement B
SSA 0920-1317 NHSN COVID-19 Module_final.docx Supporting Statement A
NHSN COVID-19 Hospital Module (Infusion Centers and Outpatient Clinics reporting Inventory & use of therapeutics (MABs) Form and Instruction
NHSN COVID-19 Hospital Module (Hospitals) Form and Instruction
Healthcare Personnel Safety Monthly Reporting Plan - completed by Inpatient Psychiatric Facilities Form and Instruction
Healthcare Personnel Safety Monthly Reporting Plan - completed by Dialysis Facilities Form and Instruction
Monthly Reporting Plan form for Long-term Care Facilities Form and Instruction
Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities Form and Instruction
Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities Form and Instruction
Weekly Healthcare Personnel COVID-19 Vaccination Cumulative Summary Form and Instruction
VA - Staff and Personnel COVID-19 Event Form - LTCF Form and Instruction
VA - Resident COVID-19 Event Form - LTCF Form and Instruction
Resident Therapeutics - State and Local Health Dept. Occupations Form and Instruction
Resident Therapeutics - Business and Financial Operations Occupations Form and Instruction
Resident Therapeutics - LTCF Personnel Form and Instruction
Dialysis Component Form and Instruction
Staff and Personnel Impact - State and Local Health Dept Occupations retrospective Form and Instruction
Staff and Personnel Impact - Business and Financial Operations Occupations retrospective Form and Instruction
Staff and Personnel Impact - LTCF Personnel retrospective Form and Instruction
Staff and Personnel Impact - State and Local Health Dept Occupations Form and Instruction
Staff and Personnel Impact - Business and Financial Operations Occupations Form and Instruction
Staff and Personnel Impact - LTCF Personnel Form and Instruction
Resident Impact and Facility Capacity - State and Local Health Dept Occupations retrospective Form and Instruction
Resident Impact and Facility Capacity - Business and Financial Operations Occupations retrospective Form and Instruction
Resident Impact and Facility Capacity - LTCF Personnel retrospective Form and Instruction
Resident Impact and Facility Capacity - LTCF Personnel, Business and Financial operations and State and Local Health Dept. Occupations Form and Instruction
NHSN and Secure Access Management Services (SAMS) enrollment Form and Instruction