OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

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

ICR 202410-0920-012 · OMB 0920-1317 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Form 57.510 57.510 COVID–19 Module Dialysis Outpatient Facility-CSV Form and Instruction New Repair queued
Form 57.509 57.509 Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities-.CSV Form and Instruction New Repair queued
Form 57.221 57.221 Healthcare Personnel COVID-19 Person Level Vaccination-Healthcare Personnel Safety Component_CSV Form and Instruction New Repair queued
Form 57.221 57.221 Healthcare Personnel COVID-19 Person Level Vaccination-Healthcare Personnel Safety Component_Manual Form and Instruction New Repair queued
Form 57.221 57.221 Healthcare Personnel COVID-19 Person Level Vaccination-LTC Component_CSV Form and Instruction New Repair queued
Form 57.221 57.221 Healthcare Personnel COVID-19 Person Level Vaccination-LTC Component _Manual Form and Instruction New Repair queued
Form 57.220 57.220 Weekly Person Level Respiratory Pathogen and Vaccination for Residents-LTCF Component_CSV Form and Instruction New Repair queued
Form 57.220 57.220 Weekly Person Level Respiratory Pathogen and Vaccination for Residents-LTCF Component_Manual Form and Instruction New Repair queued
Form 57.155 57.155 Point of Care Testing Results - CSV Form and Instruction New Repair queued
Form 57.219 Weekly Healthcare Personnel COVID-19 Vaccination Cumulative Summary (.csv) Form and Instruction Unchanged Repair queued
Form 57.218 Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities (.csv) Form and Instruction Unchanged Repair queued
Form 57.217 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel (.csv) Form and Instruction Modified Repair queued
Form 57.217 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel (manual) Form and Instruction Modified Repair queued
Form 57.216 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents (.csv) Form and Instruction Modified Repair queued
Form 57.216 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents (manual) Form and Instruction Modified Repair queued
Form 57.102 57.102 - Hospital Respiratory Data Fomr (Daily - API) Form and Instruction Unchanged Repair queued
Form 57.102 57.102 Hospital Respiratory Data Form (Daily - .csv import) Form and Instruction Unchanged Repair queued
Form 57.102 57.102 - Hospital Respiratory Data Form (Daily - user entry) Form and Instruction Unchanged Repair queued
Form 0920-1317 57.101 Hospital Respiratory Data Form (Weekly - API) Form and Instruction Unchanged Repair queued
Form 0920-1317 57.101 Hospital Respiratory Data Form (Weekly - .csv import) Form and Instruction Unchanged Available
Form 0920-1317 57.101 Hospital Respiratory Data Form (Weekly - User Entry) Form and Instruction Unchanged Repair queued
Form 57.155 57.155 Point of Care Testing Results - Manual Form and Instruction Modified Repair queued
NHSN COVID-19 Hospital Module (Infusion Centers and Outpatient Clinics reporting Inventory & use of therapeutics (MABs) Form and Instruction Removed Repair queued
Form CDC Form 57.203 Healthcare Personnel Safety Monthly Reporting Plan - completed by Inpatient Psychiatric Facilities Form and Instruction Removed Repair queued
Form CDC Form 57.203 Healthcare Personnel Safety Monthly Reporting Plan - completed by Dialysis Facilities Form and Instruction Removed Repair queued
Form CDC Form 57.141 Monthly Reporting Plan form for Long-term Care Facilities Form and Instruction Removed Repair queued
Form 57.509 57.509 Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities_Manual Form and Instruction Modified Repair queued
Form 57.218 Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities (manual) Form and Instruction Unchanged Repair queued
Form 57.219 Weekly Healthcare Personnel COVID-19 Vaccination Cumulative Summary (manual) Form and Instruction Unchanged Repair queued
Form 0920-1317 VA - Staff and Personnel COVID-19 Event Form - LTCF Form and Instruction Removed Repair queued
Form 0920-1317 VA - Resident COVID-19 Event Form - LTCF Form and Instruction Removed Missing upstream
Form 57.510 57.510 COVID–19 Module Dialysis Outpatient Facility_Manual Form and Instruction Modified Repair queued
Form CDC 57.145 Staff and Personnel Impact - State and Local Health Dept Occupations retrospective Form and Instruction Removed Missing upstream
Form CDC 57.145 Staff and Personnel Impact - Business and Financial Operations Occupations retrospective Form and Instruction Removed Available
Form CDC 57.145 Staff and Personnel Impact - LTCF Personnel retrospective Form and Instruction Removed Repair queued
Form CDC 57.145 Staff and Personnel Impact - State and Local Health Dept Occupations Form and Instruction Removed Repair queued
Form CDC 57.145 Staff and Personnel Impact - Business and Financial Operations Occupations Form and Instruction Removed Repair queued
Form CDC 57.145 Staff and Personnel Impact - LTCF Personnel Form and Instruction Removed Repair queued
Form CDC 57.144 Long Term Care Facility Resident Impact and Facility Capacity Pathway Form and Instruction Removed Repair queued
Form 0920-1317 57.140 NHSN and Secure Access Management Services (SAMS) enrollment Form and Instruction Modified Repair queued
D. Explanation for Program Changes or Adjustments.docx Supplementary Document Uploaded 2024-10-29 Repair queued
G2. Privacy Impact Assessment.pdf Supplementary Document Uploaded 2024-10-29 Missing upstream
G1. Privacy Impact Assessment.pdf Supplementary Document Uploaded 2024-10-29 Repair queued
G. Privacy Impact Assessment.pdf Supplementary Document Uploaded 2024-10-29 Missing upstream
E3. Human Subjects Determination.pdf Supplementary Document Uploaded 2024-10-29 Missing upstream
B. FRN-60 day.pdf Supplementary Document Uploaded 2024-10-29 Repair queued
SSB 0920-1317 NHSN COVID-19_FINAL.docx Supporting Statement B Uploaded 2024-10-29 Repair queued
SSA 0920-1317 NHSN COVID-19_FINAL.docx Supporting Statement A Uploaded 2024-10-29 Repair queued
Change Memo 0920-1317 August 2024_FINAL_v2.docx Justification for No Material/Nonsubstantive Change Uploaded 2024-08-22 Repair queued
Change Memo 0920-1317.docx Justification for No Material/Nonsubstantive Change Uploaded 2024-08-06 Repair queued
Change Request Memo NHSN COVID-19 0920-1317_26APR2024 v2.docx Justification for No Material/Nonsubstantive Change Uploaded 2024-04-26 Repair queued
Change Memo for CDC NHSN COVID-19 OMB Package 0920-1317.docx Justification for No Material/Nonsubstantive Change Uploaded 2024-03-14 Repair queued
Resident Impact and Facility Capacity- csv temp..csv Supplementary Document Uploaded 2023-09-07 Repair queued
TOI-Facility Importing COVID-19 and Respiratory Infections using a .csv file_RIFC.docx Supplementary Document Uploaded 2023-09-07 Available
Change Memo for NHSN September 2023_0920_1317.docx Justification for No Material/Nonsubstantive Change Uploaded 2023-09-07 Repair queued
Crosswalk_57.218.docx Supplementary Document Uploaded 2023-09-07 Repair queued
Crosswalk_57.144.docx Supplementary Document Uploaded 2023-09-07 Missing upstream
Crosswalk-COVID-19 Hospital Data.docx Supplementary Document Uploaded 2023-09-07 Repair queued
Crosswalk 11.4 updated COVID JUNE_final.docx Supplementary Document Uploaded 2023-05-18 Repair queued
Change Memo for NHSN May 2023_0920_1317_final.docx Justification for No Material/Nonsubstantive Change Uploaded 2023-05-18 Repair queued
CDC Response to APIC Dec29 letter sk lw.docx Supplementary Document Uploaded 2023-03-06 Repair queued
5. NHSN - Report of End of Human Research Review 0.1253.docx Supplementary Document Uploaded 2022-11-28 Repair queued
6. IRB Protocol Closure.pdf Supplementary Document Uploaded 2022-11-28 Repair queued
3. Privacy Act Checklist 2022.docx Supplementary Document Uploaded 2022-11-28 Repair queued
1c. 42 USC 242m.PDF Supplementary Document Uploaded 2022-11-28 Repair queued
1b. 42 USC 242k.PDF Supplementary Document Uploaded 2022-11-28 Missing upstream
1a. 42 USC 242b.PDF Supplementary Document Uploaded 2022-11-28 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
271955 57.510 COVID–19 Module Dialysis Outpatient Facility-CSV Form and Instruction New
271950 57.509 Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities-.CSV Form and Instruction New
271948 57.221 Healthcare Personnel COVID-19 Person Level Vaccination-Healthcare Personnel Safety Component_CSV Form and Instruction New
271947 57.221 Healthcare Personnel COVID-19 Person Level Vaccination-Healthcare Personnel Safety Component_Manual Form and Instruction New
271946 57.221 Healthcare Personnel COVID-19 Person Level Vaccination-LTC Component_CSV Form and Instruction New
271945 57.221 Healthcare Personnel COVID-19 Person Level Vaccination-LTC Component _Manual Form and Instruction New
271943 57.220 Weekly Person Level Respiratory Pathogen and Vaccination for Residents-LTCF Component_CSV Form and Instruction New
271941 57.220 Weekly Person Level Respiratory Pathogen and Vaccination for Residents-LTCF Component_Manual Form and Instruction New
271935 57.155 Point of Care Testing Results - CSV Form and Instruction New
270333 Weekly Healthcare Personnel COVID-19 Vaccination Cumulative Summary (.csv) Form and Instruction Unchanged
270316 Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities (.csv) Form and Instruction Unchanged
270313 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel (.csv) Form and Instruction Modified
270312 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel (manual) Form and Instruction Modified
270310 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents (.csv) Form and Instruction Modified
270309 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents (manual) Form and Instruction Modified
269868 57.102 - Hospital Respiratory Data Fomr (Daily - API) Form and Instruction Unchanged
269867 57.102 Hospital Respiratory Data Form (Daily - .csv import) Form and Instruction Unchanged
269866 57.102 - Hospital Respiratory Data Form (Daily - user entry) Form and Instruction Unchanged
269865 57.101 Hospital Respiratory Data Form (Weekly - API) Form and Instruction Unchanged
269864 57.101 Hospital Respiratory Data Form (Weekly - .csv import) Form and Instruction Unchanged
269863 57.101 Hospital Respiratory Data Form (Weekly - User Entry) Form and Instruction Unchanged
266012 57.155 Point of Care Testing Results - Manual Form and Instruction Modified
257194 NHSN COVID-19 Hospital Module (Infusion Centers and Outpatient Clinics reporting Inventory & use of therapeutics (MABs) Form and Instruction Removed
249439 Healthcare Personnel Safety Monthly Reporting Plan - completed by Inpatient Psychiatric Facilities Form and Instruction Removed
249438 Healthcare Personnel Safety Monthly Reporting Plan - completed by Dialysis Facilities Form and Instruction Removed
249437 Monthly Reporting Plan form for Long-term Care Facilities Form and Instruction Removed
249436 57.509 Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities_Manual Form and Instruction Modified
249435 Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities (manual) Form and Instruction Unchanged
249434 Weekly Healthcare Personnel COVID-19 Vaccination Cumulative Summary (manual) Form and Instruction Unchanged
247669 VA - Staff and Personnel COVID-19 Event Form - LTCF Form and Instruction Removed
247668 VA - Resident COVID-19 Event Form - LTCF Form and Instruction Removed
243719 57.510 COVID–19 Module Dialysis Outpatient Facility_Manual Form and Instruction Modified
243711 Staff and Personnel Impact - State and Local Health Dept Occupations retrospective Form and Instruction Removed
243710 Staff and Personnel Impact - Business and Financial Operations Occupations retrospective Form and Instruction Removed
243709 Staff and Personnel Impact - LTCF Personnel retrospective Form and Instruction Removed
243708 Staff and Personnel Impact - State and Local Health Dept Occupations Form and Instruction Removed
243707 Staff and Personnel Impact - Business and Financial Operations Occupations Form and Instruction Removed
243706 Staff and Personnel Impact - LTCF Personnel Form and Instruction Removed
243702 Long Term Care Facility Resident Impact and Facility Capacity Pathway Form and Instruction Removed
243698 57.140 NHSN and Secure Access Management Services (SAMS) enrollment Form and Instruction Modified
ICR Details
0920-1317 202410-0920-012
Received in OIRA 202408-0920-011
HHS/CDC 0920-1317
[NCEZID] National Healthcare Safety Network (NHSN) Coronavirus (COVID-19) Surveillance in Healthcare Facilities
Revision of a currently approved collection   No
Regular 10/30/2024
  Requested Previously Approved
36 Months From Approved 03/31/2026
3,653,433 6,086,324
1,752,540 2,766,084
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 Revision ICR is submitted to add 2 new data collection forms and make modifications/revisions to 10 currently approved data collection instruments and remove 13 instruments that are being retired from the package. . There is a net decrease in burden.to 1,752,540 hours.
US Code: 42 USC 242b, k, m Name of Law: U.S. Public Health Service Act (PHSA)
  
None
Not associated with rulemaking
  89 FR 47962 06/04/2024
89 FR 84146 10/21/2024
Yes
27
IC Title Form No. Form Name
57.101 Hospital Respiratory Data Form (Weekly - .csv import) 0920-1317 Hospital Respiratory Data Weekly Reporting Form
57.101 Hospital Respiratory Data Form (Weekly - API) 0920-1317 Hospital Respiratory Data Weekly Reporting Form
57.101 Hospital Respiratory Data Form (Weekly - User Entry) 0920-1317 Hospital Respiratory Data Weekly Reporting Form
57.102 - Hospital Respiratory Data Fomr (Daily - API) 57.102 Hospital Respiratory Data Daily Reporting Form 14AUG2024
57.102 - Hospital Respiratory Data Form (Daily - user entry) 57.102 Hospital Respiratory Data Daily Reporting Form 14AUG2024
57.102 Hospital Respiratory Data Form (Daily - .csv import) 57.102 Hospital Respiratory Data Daily Reporting Form 14AUG2024
57.140 NHSN and Secure Access Management Services (SAMS) enrollment 0920-1317 NHSN Registration Form
57.155 Point of Care Testing Results - CSV 57.155 Point of Care Testing Results
57.155 Point of Care Testing Results - Manual 57.155 Point of Care Testing Results
57.220 Weekly Person Level Respiratory Pathogen and Vaccination for Residents-LTCF Component_CSV 57.220 Weekly Person Level Respiratory Pathogen and Vaccination for Residents-LTCF Component_CSV
57.220 Weekly Person Level Respiratory Pathogen and Vaccination for Residents-LTCF Component_Manual 57.220 Weekly Person Level Respiratory Pathogen and Vaccination for Residents-LTCF Component_Manual
57.221 Healthcare Personnel COVID-19 Person Level Vaccination-Healthcare Personnel Safety Component_CSV 57.221 57.221 Healthcare Personnel COVID-19 Person Level Vaccination-Healthcare Personnel Safety Component_CSV
57.221 Healthcare Personnel COVID-19 Person Level Vaccination-Healthcare Personnel Safety Component_Manual 57.221 57.221 Healthcare Personnel COVID-19 Person Level Vaccination-Healthcare Personnel Safety Component_Manual
57.221 Healthcare Personnel COVID-19 Person Level Vaccination-LTC Component _Manual 57.221 Healthcare Personnel COVID-19 Person Level Vaccination-LTC Component_Manual
57.221 Healthcare Personnel COVID-19 Person Level Vaccination-LTC Component_CSV 57.221 Healthcare Personnel COVID-19 Person Level Vaccination-LTC Component_CSV
57.509 Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities-.CSV 57.509 57.509 Weekly COVID-19 Vaccination Cumulative Summary for Dialysis Patients_CSV
57.509 Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities_Manual 57.509 Weekly COVID-19 Vaccination Cumulative Summary for Dialysis Patients_Manual
57.510 COVID–19 Module Dialysis Outpatient Facility-CSV 57.510 57.510 COVID–19 Module Dialysis Outpatient Facility-.csv
57.510 COVID–19 Module Dialysis Outpatient Facility_Manual 57.510 COVID–19 Module - Dialysis Outpatient Facility
Healthcare Personnel Safety Monthly Reporting Plan - completed by Dialysis Facilities CDC Form 57.203 Healthcare Personnel Safety Monthly Reporting Plan
Healthcare Personnel Safety Monthly Reporting Plan - completed by Inpatient Psychiatric Facilities CDC Form 57.203 Healthcare Personnel Safety Monthly Reporting Plan
Long Term Care Facility Resident Impact and Facility Capacity Pathway 57.144, CDC 57.144 Resident Impact and Facility Capacity ,   COVID-19 and Respiratory Infections Module Long Term Care Facility Resident Impact and Facility Capacity Pathway Form (57.144) 07SEP2023
Monthly Reporting Plan form for Long-term Care Facilities CDC Form 57.141 Monthly Reporting Plan for LTCF
NHSN COVID-19 Hospital Module (Infusion Centers and Outpatient Clinics reporting Inventory & use of therapeutics (MABs) n/a NHSN COVID-19 Hospital Module Infusion Centers and Outpatient Clinics
Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel (.csv) 57.217 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel
Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel (manual) 57.217 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel
Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents (.csv) 57.216 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents
Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents (manual) 57.216 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents
Staff and Personnel Impact - Business and Financial Operations Occupations 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 - LTCF Personnel 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 - State and Local Health Dept Occupations 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
VA - Resident COVID-19 Event Form - LTCF 0920-1317 VA COVID-19 Resident Event Form
VA - Staff and Personnel COVID-19 Event Form - LTCF 0920-1317 VA - Staff and Personnel COVID-19 Event Form
Weekly Healthcare Personnel COVID-19 Vaccination Cumulative Summary (.csv) 57.219 Healthcare Personnel COVID-19 Vaccination Cumulative Summary
Weekly Healthcare Personnel COVID-19 Vaccination Cumulative Summary (manual) 57.219 Healthcare Personnel COVID-19 Vaccination Cumulative Summary
Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities (.csv) 57.218 Weekly Respiratory Pathogen and Vaccination Summary for Residents of Long-Term Care Facilities
Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities (manual) 57.218 Weekly Respiratory Pathogen and Vaccination Summary for Residents of Long-Term Care Facilities
  Total Request 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 3,653,433 6,086,324 0 -2,432,891 0 0
Annual Time Burden (Hours) 1,752,540 2,766,084 0 -1,013,544 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
Yes
Miscellaneous Actions
Revision of OMB Control No. 0920-1317 is submitted to add 2 new data collection forms and make modifications/revisions to 10 currently approved data collection instruments and remove 13 instruments that are being retired from the package. There is a net decrease in burden.to 1,752,540 hours.
$49,992,135
Yes Part B of Supporting Statement
    Yes
    No
No
No
No
Yes
Odion Clunis 770 488-0045 [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.
10/30/2024