Information Collection Request

National Healthcare Safety Network (NHSN) Patient Impact Module for Coronavirus (COVID-19) Surveillance in Healthcare Facilities

ICR 202006-0920-014 · OMB 0920-1290 · Historical Inactive

Forms and Documents
DocumentTypeStatusAvailability
Form 0920-1290 State and Local Health Department - Resident Impact / Facility Capacity Form (Retrospective Datat Entry) Form and Instruction Unchanged Available
Form 0920-1290 Business and Financial Operations Occupations - Resident Impact/Facility Capacity Form - Retrospective Data Entry Form and Instruction Unchanged Repair queued
Form 0920-1290 LTCF Personnel - Resident Impact/Facility Capacity - Retrospective Data Entry Form and Instruction Unchanged Available
Form 0920-1290 State and Local Health Departments - Staff and Personnel Impact - Retrospective Data Entry Form and Instruction Unchanged Repair queued
Form 0920-1290 Business and Financial Operations Occupations - Staff and Personnel Impact - Retrospective Data Entry Form and Instruction Unchanged Repair queued
Form 0920-1290 LTCF Personnel - Staff and Personnel Impact - Retrospective Data Entry Form and Instruction Unchanged Repair queued
Form 0920-1290 NHSN and Secure Access Management Services (SAMS) Enrollment Form and Instruction Unchanged Repair queued
LTC Supplies and PPE - state/local health depts. Form Unchanged Available
LTC Supplies and PPE - business operations occupations Form Unchanged Repair queued
LTC Supplies and PPE - microbiologists Form Unchanged Repair queued
LTC Ventilator Capacity - state/local health depts. Form Unchanged Repair queued
LTC Ventilator Capacity - business operations occupations Form Unchanged Repair queued
LTC Ventilator Capacity - microbiologists Form Unchanged Repair queued
LTC Resident Impact - state/local health depts. Form Unchanged Repair queued
LTC Resident Impact - business operations occupations Form Unchanged Repair queued
LTC Resident Impact - microbiologist Form Unchanged Repair queued
LTC Staff and Personnel Impact - state/local health depts. Form Unchanged Repair queued
LTC Staff and Personnel Impact - business operations occupations Form Unchanged Available
LTC Staff and Personnel Impact - microbiologist Form Unchanged Repair queued
Form 0920-1290 COVID-19 Supplies Form - State and Local Health Department Form and Instruction Modified Repair queued
Form 0920-1290 COVID-19 Supplies Form - Business/Financial Operations Form and Instruction Modified Repair queued
Form 0920-1290 COVID-19 Supplies Form - Microbiologist Form and Instruction Modified Repair queued
Form 0920-1290 COVID-19 Healthcare Worker Form - State and Local Health Department Form and Instruction Unchanged Repair queued
Form 0920-1290 COVID-19 Healthcare Worker Form - Business/Financial Operations Form and Instruction Unchanged Repair queued
Form 0920-1290 COVID-19 Healthcare Worker Form - Microbiologist Form and Instruction Unchanged Repair queued
COVID-19 Patient Impact Module Form - Business/Financial Operations Form Unchanged Repair queued
Form 0920-1290 COVID-19 Patient Impact Module Form - Microbiologist Form Unchanged Repair queued
Hospital and Lab Data Submission FAQ UPDATED 062420_1248_withRed_Draft.docx Supplementary Document Uploaded 2020-07-01 Repair queued
0920-1290 Change Memo - NHSN COVID-19 supply changes FINAL.docx Justification for No Material/Nonsubstantive Change Uploaded 2020-06-22 Repair queued
0920-1290 Change Memo - NHSN COVID-19 PIHC changes 05292020.docx Justification for No Material/Nonsubstantive Change Uploaded 2020-05-29 Repair queued
0920-1290 Change Memo - NHSN COVID-19 PIHC changes 050820.docx Justification for No Material/Nonsubstantive Change Uploaded 2020-05-14 Repair queued
3. Upcoming Additional and Modified Fields for Acute Care COVID-19 Module.pdf Supplementary Document Uploaded 2020-05-14 Available
4. BlastEmail_ allPSFacs for Friday morn_DRAFT_ (002) clean.docx Supplementary Document Uploaded 2020-05-14 Repair queued
Change Request Memo 07MAY2020.docx Justification for No Material/Nonsubstantive Change Uploaded 2020-05-12 Repair queued
CDC 57.145_TOI_Staff and Personnel Impact (OMB)_6May2020_FINAL.docx Supplementary Document Uploaded 2020-05-07 Repair queued
CDC 57.144_TOI_Resident Impact and Facility Capacity (OMB)_6May2020_FINAL.docx Supplementary Document Uploaded 2020-05-07 Repair queued
Change Request Memo 07MAY2020.docx Justification for No Material/Nonsubstantive Change Uploaded 2020-05-07 Repair queued
CDC 57.147_TOI_Ventilator Capacity and Supplies.docx Supplementary Document Uploaded 2020-05-01 Repair queued
CDC 57.146 TOI_Supplies and Personal Protective Equipment.docx Supplementary Document Uploaded 2020-05-01 Repair queued
0920-1290 Change Memo - NHSN COVID-19 LTCF_4-30-20.docx Justification for No Material/Nonsubstantive Change Uploaded 2020-05-01 Repair queued
Supporting Statement A NHSN COVID-19_042220 clean.docx Supporting Statement A Uploaded 2020-04-23 Available
0920-1290 Change Request- NHSN COVID-19 LTCF_4-22-20 clean.docx Justification for No Material/Nonsubstantive Change Uploaded 2020-04-23 Repair queued
HDCommunication FINAL 10APR2020.docx Supplementary Document Uploaded 2020-04-10 Repair queued
0920-1290 Change Request- NHSN COVID-19 Module 04092020.docx Justification for No Material/Nonsubstantive Change Uploaded 2020-04-09 Repair queued
Att4c_How to Enter and Access COVID Summary Data.docx Supplementary Document Uploaded 2020-03-24 Repair queued
Revised Emergency Request Memo 23MAR2020.docx Supplementary Document Uploaded 2020-03-23 Repair queued
Att6_NHSN Report of End of Human Research Review.docx Supplementary Document Uploaded 2020-03-23 Available
Att5_Closure of CDC Protocol 4062.docx Supplementary Document Uploaded 2020-03-23 Repair queued
Att1c_42 USC 242m.pdf Supplementary Document Uploaded 2020-03-23 Repair queued
Att1b_42 USC 242k.pdf Supplementary Document Uploaded 2020-03-23 Available
Att1a_42 USC 242b.pdf Supplementary Document Uploaded 2020-03-23 Repair queued
Att3_PIA.pdf Supplementary Document Uploaded 2020-03-23 Repair queued
Supporting Statement B NHSN COVID-19_clean.docx Supporting Statement B Uploaded 2020-03-24 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
242552 TeleTracking (TT) - U.S. Healthcare COVID-19 Portal New
241810 State and Local Health Department - Resident Impact / Facility Capacity Form (Retrospective Datat Entry) Form and Instruction Unchanged
241809 Business and Financial Operations Occupations - Resident Impact/Facility Capacity Form - Retrospective Data Entry Form and Instruction Unchanged
241808 LTCF Personnel - Resident Impact/Facility Capacity - Retrospective Data Entry Form and Instruction Unchanged
241807 State and Local Health Departments - Staff and Personnel Impact - Retrospective Data Entry Form and Instruction Unchanged
241806 Business and Financial Operations Occupations - Staff and Personnel Impact - Retrospective Data Entry Form and Instruction Unchanged
241805 LTCF Personnel - Staff and Personnel Impact - Retrospective Data Entry Form and Instruction Unchanged
241679 NHSN and Secure Access Management Services (SAMS) Enrollment Form and Instruction Unchanged
241498 LTC Supplies and PPE - state/local health depts. Form Unchanged
241497 LTC Supplies and PPE - business operations occupations Form Unchanged
241496 LTC Supplies and PPE - microbiologists Form Unchanged
241495 LTC Ventilator Capacity - state/local health depts. Form Unchanged
241494 LTC Ventilator Capacity - business operations occupations Form Unchanged
241493 LTC Ventilator Capacity - microbiologists Form Unchanged
241492 LTC Resident Impact - state/local health depts. Form Unchanged
241491 LTC Resident Impact - business operations occupations Form Unchanged
241490 LTC Resident Impact - microbiologist Form Unchanged
241489 LTC Staff and Personnel Impact - state/local health depts. Form Unchanged
241488 LTC Staff and Personnel Impact - business operations occupations Form Unchanged
241487 LTC Staff and Personnel Impact - microbiologist Form Unchanged
241303 COVID-19 Supplies Form - State and Local Health Department Form and Instruction Modified
241302 COVID-19 Supplies Form - Business/Financial Operations Form and Instruction Modified
241301 COVID-19 Supplies Form - Microbiologist Form and Instruction Modified
241300 COVID-19 Healthcare Worker Form - State and Local Health Department Form and Instruction Unchanged
241299 COVID-19 Healthcare Worker Form - Business/Financial Operations Form and Instruction Unchanged
241298 COVID-19 Healthcare Worker Form - Microbiologist Form and Instruction Unchanged
241297 COVID-19 Patient Impact Module Form - State and Local Health Departments Instruction Unchanged
241296 COVID-19 Patient Impact Module Form - Business/Financial Operations Form Unchanged
240833 COVID-19 Patient Impact Module Form - Microbiologist Form Unchanged
ICR Details
0920-1290 202006-0920-014
Historical Inactive 202005-0920-014
HHS/CDC 0920-1290
National Healthcare Safety Network (NHSN) Patient Impact Module for Coronavirus (COVID-19) Surveillance in Healthcare Facilities
No material or nonsubstantive change to a currently approved collection   No
Emergency 03/24/2020
Withdrawn and continue 07/02/2020
Retrieve Notice of Action (NOA) 07/01/2020
  Inventory as of this Action Requested Previously Approved
09/30/2020 09/30/2020 09/30/2020
3,235,450 0 3,235,450
1,206,491 0 1,206,491
0 0 0

The goal of this information collection is to 1) capture the daily, aggregate impact of COVID-19 on healthcare facilities, and 2) monitor medical capacity to respond at local, state, and national levels. This information will be used to inform the overall real-time COVID-19 response efforts and possible resource allocation, and enable state and local health departments to gain immediate access to the COVID-19 data for hospitals within their jurisdiction. Information collection for long term care facilities are being added to this request. This Change Request will add nine data elements to the Patient Impact and Hospital Capacity form and will add TeleTracking to the NHSN collection at the request the White House Coronavirus Task Force in order to strengthen COVID-19 response efforts.
I have determined that the information must be collected prior to the expiration of time period established under Part 1320, and that this information is essential to CDC’s ability, as well as that of state and local health departments, to effectively address the national public health crisis caused by the Novel Coronavirus (COVID-19). As rates of infection and resulting deaths continue to rise across the nation, healthcare facilities and public health departments are facing significant strain on patient care and infection prevention efforts. NHSN plans to introduce a new surveillance module that will enable hospitals to report daily COVID-19 patient counts to NHSN, and NHSN in turn will enable state and local health departments to gain immediate access to the COVID-19 data for hospitals in their jurisdiction. COVID-19 data submitted to NHSN also will be used immediately by CDC’s emergency COVID-19 response. NHSN’s role as a shared platform for healthcare-associated infection surveillance provides a valuable foundation for COVID-19 surveillance. The COVID-19 modules can additionally be adapted for future outbreaks of COVID or other infectious diseases. A large majority of the nation’s hospitals already participate in NHSN, and infection preventionists (IPs) in those hospitals use NHSN for surveillance and reporting of healthcare-associated infection and antimicrobial resistance. CDC cannot reasonably comply with the normal clearance procedures due to the public harm that could escalate if routine processing of this request is required. CDC requests authorization to use information collection instruments in the existing NHSN web-based application for 180 days to enable immediate CDC and public health departments with immediate access to COVID-19 patient impact data.

US Code: 42 USC 242b, 242k, 242m Name of Law: Public Health Service Act
  
None

Not associated with rulemaking

No

29
IC Title Form No. Form Name
TeleTracking (TT) - U.S. Healthcare COVID-19 Portal
LTC Supplies and PPE - business operations occupations none LTC Supplies and PPE
COVID-19 Healthcare Worker Form - Microbiologist 0920-1290 COVID-19 Healthcare Worker Form
COVID-19 Healthcare Worker Form - Business/Financial Operations 0920-1290 COVID-19 Healthcare Worker Form
COVID-19 Supplies Form - State and Local Health Department 0920-1290, 0920-1290 COVID-19 Supplies Form ,   COVID-19 Module - Hospital Supply Pathway 19JUN2020
COVID-19 Patient Impact Module Form - Microbiologist 0920-1290, 00920-1290, NA COVID-19 Patient Impact Module Form - 14MAY2020 ,   COVID-19 Patient Impact Module Form ,   COVID-19 Patient Impact Module Form 29MAY2020
COVID-19 Patient Impact Module Form - State and Local Health Departments 0920-1290, 0920-1290, NA COVID-19 Patient Impact Module Form ,   COVID-19 Patient Impact Module Form - 14MAY2020 ,   COVID-19 Patient Impact Module Form 29MAY2020
COVID-19 Healthcare Worker Form - State and Local Health Department 0920-1290 COVID-19 Healthcare Worker Form
COVID-19 Supplies Form - Microbiologist 0920-1290, 0920-1290 COVID-19 Supplies Form ,   COVID-19 Module - Hospital Supply Pathway 19JUN2020
LTC Supplies and PPE - microbiologists none LTC Supplies
LTC Ventilator Capacity - state/local health depts. none LTC Ventilator Capacity
COVID-19 Supplies Form - Business/Financial Operations 0920-1290, 0920-1290 COVID-19 Supplies Form ,   COVID-19 Module - Hospital Supply Pathway 19JUN2020
COVID-19 Patient Impact Module Form - Business/Financial Operations 0920-1290, 09201290, NA COVID-19 Patient Impact Module Form ,   COVID-19 Patient Impact Module Form - 14MAY2020 ,   COVID-19 Patient Impact Module Form 29MAY2020
LTC Supplies and PPE - state/local health depts. none LTC Supplies and PPE
NHSN and Secure Access Management Services (SAMS) Enrollment 0920-1290 NHSN and Secure Access Management Services (SAMS) Enrollment
LTCF Personnel - Staff and Personnel Impact - Retrospective Data Entry 0920-1290 COVID-19 Module - LTCF Staff and Personnel Impact Form (Retrospective Datat Entry)
Business and Financial Operations Occupations - Staff and Personnel Impact - Retrospective Data Entry 0920-1290 COVID-19 Module - LTCF Staff and Personnel Impact Form (Retrospective Datat Entry)
State and Local Health Departments - Staff and Personnel Impact - Retrospective Data Entry 0920-1290 COVID-19 Module - LTCF Staff and Personnel Impact Form (Retrospective Datat Entry)
Business and Financial Operations Occupations - Resident Impact/Facility Capacity Form - Retrospective Data Entry 0920-1290 COVID-19 Module - LTCF Resident Impact and Facility Capacity Form (Retrospective Datat Entry)
State and Local Health Department - Resident Impact / Facility Capacity Form (Retrospective Datat Entry) 0920-1290 COVID-19 Module - LTCF Resident Impact and Facility Capacity Form (Retrospective Datat Entry)
LTC Staff and Personnel Impact - microbiologist none LTC Staff and Personnel Impact
LTC Staff and Personnel Impact - business operations occupations none LTC Staff and Personnel Impact
LTC Staff and Personnel Impact - state/local health depts. none LTC Staff and Personnel Impact
LTC Resident Impact - microbiologist none LTC Resident impact and facility capacity
LTCF Personnel - Resident Impact/Facility Capacity - Retrospective Data Entry 0920-1290 COVID-19 Module - LTCF Resident Impact and Facility Capacity Form (Retrospective Datat Entry)
LTC Resident Impact - business operations occupations none LTC Resident Impact and Facility Capacity
LTC Resident Impact - state/local health depts. none LTC Resident impact
LTC Ventilator Capacity - microbiologists none LTC Ventilator Capacity
LTC Ventilator Capacity - business operations occupations none LTC Ventilator Capacity

Yes
Miscellaneous Actions
No
Change Request adds additional 5 minutes of burden to the COVID-19 Hospital Supply Pathway Form

$0
No
    Yes
    No
No
No
No
Yes
Jeffrey Zirger 404 639-7118 [email protected]

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
07/01/2020