Information Collection Request

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

ICR 201407-0920-009 · OMB 0920-0852 · Historical Inactive

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0920-0852 can be found here:

Forms and Documents

Document	Type	Status	Availability
Patient Information Form (PIF)	Form	Modified	Repair queued
Healthcare Facility Assessment (HFA)	Form	Modified	Repair queued
AttachmentK_FINAL_0920-0852_2014PrescribingQualityForms_20140718.pdf	Supplementary Document	Uploaded 2014-07-21	Available
AttachmentJ_FINAL_0920-0852_2014EIPHFA_20140718.pdf	Supplementary Document	Uploaded 2014-07-21	Repair queued
NonsubChange_0920-0852_SuppStateB_v9_20140718.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2014-07-21	Available
NonsubChange_0920-0852_SuppStateA_v9_20140721.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2014-07-21	Repair queued
Reinstatement_0920-0852_SuppStateB_v5_20130821.docx	Supporting Statement B	Uploaded 2013-09-25	Repair queued
AttachmentI_FINAL_0920-0852_NonResearchDeterm.pdf	Supplementary Document	Uploaded 2013-09-25	Available
AttachmentH_FINAL_0920-0852_ NCHSConsultation.rtf	Supplementary Document	Uploaded 2013-09-25	Repair queued
AttachmentI_ FINAL_0920-0852_InformationalDocument.pdf	Supplementary Document	Uploaded 2013-09-25	Available
AttachmentG_FINAL_0920-0852_SupplementalForms_20130726.docx	Supplementary Document	Uploaded 2013-09-25	Repair queued
AttachmentF_FINAL_0920-0852_PTInstructions_v1_20130620.pdf	Supplementary Document	Uploaded 2013-09-25	Repair queued
AttachmentB_FINAL_0920-0852_60 day published.pdf	Supplementary Document	Uploaded 2013-09-25	Repair queued
AttachmentC_FINAL_0920-0852_ARRA_20130618.docx	Supplementary Document	Uploaded 2013-09-25	Repair queued
Attachment A 42 USC 241.pdf	Supplementary Document	Uploaded 2013-09-25	Available
Reinstatement_0920-0852_SuppStateA_v6_20130923.doc	Supporting Statement A	Uploaded 2013-09-25	Repair queued

IC Document Collections

IC ID	Collection	Type	Status
212404	Provision of Patient Lists	Instruction	New
192452	Patient Information Form (PIF)	Form	Modified
192451	Healthcare Facility Assessment (HFA)	Form	Modified

ICR Details

OMB Control No: 0920-0852	ICR Reference No: 201407-0920-009
Status: Historical Inactive	Previous ICR Reference No: 201310-0920-002
Agency/Subagency: HHS/CDC	Agency Tracking No: 20565
Title: Prevalence Survey of Healthcare Associated Infections (HAIs) and Antimicrobial Use in U.S. Acute Care Hospitals
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Improperly submitted and continue	Conclusion Date: 07/22/2014
Retrieve Notice of Action (NOA)	Date Received in OIRA: 07/22/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2016	12/31/2016	12/31/2016
Responses	21,500	0	21,500
Time Burden (Hours)	6,325	0	6,325
Cost Burden (Dollars)	0	0	0

Abstract: This resubmission of a request for change to perform a more limited data collection in 2014 and a full scale survey in 2015 due to funding availability.

Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act
PL: Pub.L. 111 - 5 1 Name of Law: American Recovery and Reinvestment Act of 2009

Citations for New Statutory Requirements: None

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 71798	12/04/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 59700	09/27/2013
Did the Agency receive public comments on this ICR? No

Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
Provision of Patient Lists
Healthcare Facility Assessment (HFA)	none	Healthcare Facility Assessment
Patient Information Form (PIF)	none	Patient Information Form

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: This change request is to perform a limited data collection in 2014 and the full scale survey in 2015 due to the late availability of funds. Burden for the provision of patient lists is added and the number of responses to the patient information form were reduced by half.

Annual Cost to Federal Government: $1,382,732

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Yes

Is this ICR related to the Pandemic Response? Uncollected

Agency Contact: Shari Steinberg 404 639-4942 [email protected]

Common Form ICR: No