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Federal forms, ICRs, and supporting documents

Information Collection Request

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

ICR 202102-0920-015 · OMB 0920-1317 · Active

Forms and Documents
DocumentTypeStatusAvailability
Form 0920-1317 CDC 57.X Resident Therapeutics - State and Local Health Dept. Occupations Form and Instruction Unchanged Repair queued
Form 0920-1317 CDC 57.X Resident Therapeutics - Business and Financial Operations Occupations Form and Instruction Unchanged Available
Form 0920-1317 CDC 57.X Resident Therapeutics - LTCF Personnel Form and Instruction Unchanged Available
Form 0920-20LW Dialysis Component Form and Instruction Modified Repair queued
Form CDC 57.147 Ventilator Capacity & Supplies - State and Local Health Dept Occupations Form and Instruction Unchanged Available
Form CDC 57.147 Ventilator Capacity & Supplies - Business and Financial Operations Occupations Form and Instruction Unchanged Repair queued
Form CDC 57.147 Ventilator Capacity & Supplies - LCTF Personnel Form and Instruction Unchanged Repair queued
Form CDC 57.146 Supplies & Personal Protective Equipment - State and Local Health Dept Occupations Form and Instruction Modified Available
Form CDC 57.146 Supplies & Personal Protective Equipment - Business and Financial Operations Occupations Form and Instruction Modified Repair queued
Form CDC 57.146 Supplies & Personal Protective Equipment - LTCF Personnel Form and Instruction Modified Repair queued
Form CDC 57.145 Staff and Personnel Impact - State and Local Health Dept Occupations retrospective Form and Instruction Unchanged Repair queued
Form CDC 57.145 Staff and Personnel Impact - Business and Financial Operations Occupations retrospective Form and Instruction Unchanged Repair queued
Form CDC 57.145 Staff and Personnel Impact - LTCF Personnel retrospective Form and Instruction Unchanged Repair queued
Form CDC 57.145 Staff and Personnel Impact - State and Local Health Dept Occupations Form and Instruction Unchanged Repair queued
Form CDC 57.145 Staff and Personnel Impact - Business and Financial Operations Occupations Form and Instruction Unchanged Repair queued
Form CDC 57.145 Staff and Personnel Impact - LTCF Personnel Form and Instruction Unchanged Repair queued
Form CDC 57.144 Resident Impact and Facility Capacity - State and Local Health Dept Occupations retrospective Form and Instruction Unchanged Repair queued
Form CDC 57.144 Resident Impact and Facility Capacity - Business and Financial Operations Occupations retrospective Form and Instruction Unchanged Available
Form CDC 57.144 Resident Impact and Facility Capacity - LTCF Personnel retrospective Form and Instruction Unchanged Repair queued
Form CDC 57.144 Resident Impact and Facility Capacity - State and Local Health Dept Occupations Form and Instruction Unchanged Repair queued
Form CDC 57.144 Resident Impact and Facility Capacity - Business and Financial Operations Occupations Form and Instruction Unchanged Repair queued
Form CDC 57.144 Resident Impact and Facility Capacity - LTCF Personnel Form and Instruction Unchanged Available
Form 0920-20LW NHSN and Secure Access Management Services (SAMS) enrollment Form and Instruction Unchanged Available
0920-1317 Change Memo - NHSN LTCF PPE_DIALYSIS_TBG.docx Justification for No Material/Nonsubstantive Change Uploaded 2021-02-25 Repair queued
NHSN COVID Module Non-sub change request 012621.docx Justification for No Material/Nonsubstantive Change Uploaded 2021-01-28 Repair queued
Att6_NHSN Report of End of Human Research Review.docx Supplementary Document Uploaded 2020-09-21 Repair queued
Att5_Closure of CDC Protocol 4062.docx Supplementary Document Uploaded 2020-09-21 Repair queued
Att4_How to Enter and Access COVID Summary Data.docx Supplementary Document Uploaded 2020-09-21 Available
Att3_PIA.pdf Supplementary Document Uploaded 2020-09-21 Available
Att2_60 Day FRN.pdf Supplementary Document Uploaded 2020-09-21 Available
Att1c_42 USC 242m.pdf Supplementary Document Uploaded 2020-09-21 Available
Att1b_42 USC 242k.pdf Supplementary Document Uploaded 2020-09-21 Available
Att1a_42 USC 242b.pdf Supplementary Document Uploaded 2020-09-21 Repair queued
Supporting Statement B NHSN COVID-19_clean.09.01.20 .docx Supporting Statement B Uploaded 2020-09-21 Available
NHSN COVID SSA_15JAN2021.docx Supporting Statement A Uploaded 2021-01-15 Available
IC Document Collections
IC IDCollectionTypeStatusForm
245466 Resident Therapeutics - State and Local Health Dept. Occupations Form and Instruction Unchanged
245464 Resident Therapeutics - Business and Financial Operations Occupations Form and Instruction Unchanged
245463 Resident Therapeutics - LTCF Personnel Form and Instruction Unchanged
243719 Dialysis Component Form and Instruction Modified
243718 Ventilator Capacity & Supplies - State and Local Health Dept Occupations Form and Instruction Unchanged
243717 Ventilator Capacity & Supplies - Business and Financial Operations Occupations Form and Instruction Unchanged
243716 Ventilator Capacity & Supplies - LCTF Personnel Form and Instruction Unchanged
243714 Supplies & Personal Protective Equipment - State and Local Health Dept Occupations Form and Instruction Modified
243713 Supplies & Personal Protective Equipment - Business and Financial Operations Occupations Form and Instruction Modified
243712 Supplies & Personal Protective Equipment - LTCF Personnel Form and Instruction Modified
243711 Staff and Personnel Impact - State and Local Health Dept Occupations retrospective Form and Instruction Unchanged
243710 Staff and Personnel Impact - Business and Financial Operations Occupations retrospective Form and Instruction Unchanged
243709 Staff and Personnel Impact - LTCF Personnel retrospective Form and Instruction Unchanged
243708 Staff and Personnel Impact - State and Local Health Dept Occupations Form and Instruction Unchanged
243707 Staff and Personnel Impact - Business and Financial Operations Occupations Form and Instruction Unchanged
243706 Staff and Personnel Impact - LTCF Personnel Form and Instruction Unchanged
243704 Resident Impact and Facility Capacity - State and Local Health Dept Occupations retrospective Form and Instruction Unchanged
243703 Resident Impact and Facility Capacity - Business and Financial Operations Occupations retrospective Form and Instruction Unchanged
243702 Resident Impact and Facility Capacity - LTCF Personnel retrospective Form and Instruction Unchanged
243701 Resident Impact and Facility Capacity - State and Local Health Dept Occupations Form and Instruction Unchanged
243700 Resident Impact and Facility Capacity - Business and Financial Operations Occupations Form and Instruction Unchanged
243699 Resident Impact and Facility Capacity - LTCF Personnel Form and Instruction Unchanged
243698 NHSN and Secure Access Management Services (SAMS) enrollment Form and Instruction Unchanged
ICR Details
0920-1317 202102-0920-015
Active 202101-0920-017
HHS/CDC 0920-1317-21DO
National Healthcare Safety Network (NHSN) Coronavirus (COVID-19) Surveillance in Healthcare Facilities
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved with change 02/26/2021
Retrieve Notice of Action (NOA) 02/26/2021
CDC will work with its OIRA desk officer should changes due to the changing nature of the public health emergency be necessary. CDC will detail in all publications and use of the data any limitations based upon changes in respondent characteristics.
  Inventory as of this Action Requested Previously Approved
01/31/2024 01/31/2024 01/31/2024
4,530,322 0 4,530,322
1,519,695 0 1,386,566
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 healthcare facilities within their jurisdiction. This Non-Substantive Change Request is submitted to make modifications to the LTCF: Supplies and PPE, and Dialysis Component instruments.
US Code: 42 USC 242b, k, m Name of Law: The Public Health Service Act
  
None
Not associated with rulemaking
  85 FR 21443 04/17/2020
85 FR 59313 09/21/2020
Yes
23
IC Title Form No. Form Name
Resident Therapeutics - State and Local Health Dept. Occupations 0920-1317 CDC 57.XXX Long Term Care Facility: Resident Therapeutics
Resident Therapeutics - LTCF Personnel 0920-1317 CDC 57.XXX Long-Term Care Facility: Resident Therapeutics
Resident Therapeutics - Business and Financial Operations Occupations 0920-1317 CDC 57.XXX Long Term Care Facility: Resident Therapeutics
NHSN and Secure Access Management Services (SAMS) enrollment 0920-20LW NHSN Registration Form
Resident Impact and Facility Capacity - Business and Financial Operations Occupations 0920-1317 CDC 57.144, CDC 57.144 Resident Impact and Facility Capacity ,   Resident Impact and Facility Capacity
Resident Impact and Facility Capacity - State and Local Health Dept Occupations 0920-1317 CDC 57.144, CDC 57.144 Resident Impact and Facility Capacity ,   Resident Impact and Facility Capacity
Resident Impact and Facility Capacity - LTCF Personnel retrospective CDC 57.144 Resident Impact and Facility Capacity
Resident Impact and Facility Capacity - Business and Financial Operations Occupations retrospective CDC 57.144 Resident Impact and Facility Capacity
Resident Impact and Facility Capacity - State and Local Health Dept Occupations retrospective CDC 57.144 Resident Impact and Facility Capacity
Staff and Personnel Impact - LTCF Personnel CDC 57.145 Staff and Personnel Impact
Staff and Personnel Impact - Business and Financial Operations Occupations CDC 57.145 Staff and Personnel Impact
Staff and Personnel Impact - LTCF Personnel retrospective CDC 57.145 Staff and Personnel Impact
Staff and Personnel Impact - Business and Financial Operations Occupations retrospective CDC 57.145 Staff and Personnel Impact
Staff and Personnel Impact - State and Local Health Dept Occupations retrospective CDC 57.145 Staff and Personnel Impact
Supplies & Personal Protective Equipment - LTCF Personnel CDC 57.146, CDC 57.146 Supplies & Personal Protective Equipment ,   COVID-19 Module - LTCF: Supplies and Personal Protective Equipment
Supplies & Personal Protective Equipment - Business and Financial Operations Occupations CDC 57.146, CDC 57.146 Supplies & Personal Protective Equipment ,   COVID-19 Module - LTCF: Supplies and Personal Protective Equipment
Supplies & Personal Protective Equipment - State and Local Health Dept Occupations CDC 57.146, CDC 57.146 Supplies & Personal Protective Equipment ,   COVID-19 Module - LTCF: Supplies and Personal Protective Equipment
Ventilator Capacity & Supplies - LCTF Personnel CDC 57.147 Ventilator Capacity & Supplies
Ventilator Capacity & Supplies - Business and Financial Operations Occupations CDC 57.147 Ventilator Capacity & Supplies
Ventilator Capacity & Supplies - State and Local Health Dept Occupations CDC 57.147 Ventilator Capacity & Supplies
Dialysis Component 0920-20LW, 0920-1317 Dialysis Component ,   COVID-19 Module Dialysis Outpatient Facility
Resident Impact and Facility Capacity - LTCF Personnel 0920-1317 CDC 57.144, CDC 57.144 Resident Impact and Facility Capacity ,   Resident Impact and Facility Capacity
Staff and Personnel Impact - State and Local Health Dept Occupations CDC 57.145 Staff and Personnel Impact
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 4,530,322 4,530,322 0 0 0 0
Annual Time Burden (Hours) 1,519,695 1,386,566 0 133,129 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
Burden increase due to modifications made to COVID-19 Module - LTCF: Supplies and Personal Protective Equipment and Dialysis Component Forms..
$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.
02/26/2021