Information Collection Request

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

ICR 202502-0920-015 · OMB 0920-1317 · Active

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0920-1317 can be found here:

Forms and Documents

Document	Type	Status	Availability
Form 57.510 57.510 COVID–19 Module Dialysis Outpatient Facility-CSV	Form and Instruction	Unchanged	Available
Form 57.510 57.510 COVID–19 Module Dialysis Outpatient Facility-CSV	Form and Instruction	Unchanged	Repair queued
Form 57.509 57.509 Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities-.CSV	Form and Instruction	Unchanged	Available
Form 57.509 57.509 Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities-.CSV	Form and Instruction	Unchanged	Repair queued
Form 57.221 57.221 Healthcare Personnel COVID-19 Person Level Vaccination-Healthcare Personnel Safety Component_CSV	Form and Instruction	Removed	Available
Form 57.221 57.221 Healthcare Personnel COVID-19 Person Level Vaccination-Healthcare Personnel Safety Component_CSV	Form and Instruction	Removed	Repair queued
Form 57.221 57.221 Healthcare Personnel COVID-19 Person Level Vaccination-Healthcare Personnel Safety Component_Manual	Form and Instruction	Removed	Available
Form 57.221 57.221 Healthcare Personnel COVID-19 Person Level Vaccination-Healthcare Personnel Safety Component_Manual	Form and Instruction	Removed	Available
Form 57.221 57.221 Healthcare Personnel COVID-19 Person Level Vaccination-LTC Component_CSV	Form and Instruction	Removed	Available
Form 57.221 57.221 Healthcare Personnel COVID-19 Person Level Vaccination-LTC Component_CSV	Form and Instruction	Removed	Repair queued
Form 57.221 57.221 Healthcare Personnel COVID-19 Person Level Vaccination-LTC Component _Manual	Form and Instruction	Removed	Available
Form 57.221 57.221 Healthcare Personnel COVID-19 Person Level Vaccination-LTC Component _Manual	Form and Instruction	Removed	Repair queued
Form 57.220 57.220 Weekly Person Level Respiratory Pathogen and Vaccination for Residents-LTCF Component_CSV	Form and Instruction	Removed	Available
Form 57.220 57.220 Weekly Person Level Respiratory Pathogen and Vaccination for Residents-LTCF Component_CSV	Form and Instruction	Removed	Repair queued
Form 57.220 57.220 Weekly Person Level Respiratory Pathogen and Vaccination for Residents-LTCF Component_Manual	Form and Instruction	Removed	Available
Form 57.220 57.220 Weekly Person Level Respiratory Pathogen and Vaccination for Residents-LTCF Component_Manual	Form and Instruction	Removed	Repair queued
Form 57.155 57.155 Point of Care Testing Results - CSV	Form and Instruction	Modified	Available
Form 57.155 57.155 Point of Care Testing Results - CSV	Form and Instruction	Modified	Missing upstream
Form 57.219 Weekly Healthcare Personnel COVID-19 Vaccination Cumulative Summary (.csv)	Form and Instruction	Unchanged	Available
Form 57.219 Weekly Healthcare Personnel COVID-19 Vaccination Cumulative Summary (.csv)	Form and Instruction	Unchanged	Available
Form 57.218 Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities (.csv)	Form and Instruction	Unchanged	Available
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	Available
Form 57.217 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel (.csv)	Form and Instruction	Modified	Missing upstream
Form 57.217 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel (manual)	Form and Instruction	Modified	Available
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	Available
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	Available
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	Available
Form 57.102 57.102 - Hospital Respiratory Data Fomr (Daily - API)	Form and Instruction	Unchanged	Missing upstream
Form 57.102 57.102 Hospital Respiratory Data Form (Daily - .csv import)	Form and Instruction	Unchanged	Available
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	Available
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	Available
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 - .csv import)	Form and Instruction	Unchanged	Missing upstream
Form 0920-1317 57.101 Hospital Respiratory Data Form (Weekly - User Entry)	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	Available
Form 57.155 57.155 Point of Care Testing Results - Manual	Form and Instruction	Modified	Repair queued
Form 57.509 57.509 Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities_Manual	Form and Instruction	Unchanged	Available
Form 57.509 57.509 Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities_Manual	Form and Instruction	Unchanged	Repair queued
Form Form 57.218 Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities (manual)	Form and Instruction	Unchanged	Available
Form 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	Available
Form 57.219 Weekly Healthcare Personnel COVID-19 Vaccination Cumulative Summary (manual)	Form and Instruction	Unchanged	Repair queued
Form 57.510 57.510 COVID–19 Module Dialysis Outpatient Facility_Manual	Form and Instruction	Unchanged	Available
Form 57.510 57.510 COVID–19 Module Dialysis Outpatient Facility_Manual	Form and Instruction	Unchanged	Repair queued
Form 0920-1317 57.140 NHSN and Secure Access Management Services (SAMS) enrollment	Form and Instruction	Unchanged	Repair queued
Form 0920-1317 57.140 NHSN and Secure Access Management Services (SAMS) enrollment	Form and Instruction	Unchanged	Missing upstream
Change Request Memo - EO14168.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-03-04	Available
Change Request Memo - EO14168.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-03-04	Repair queued
Change Memo 0920-1317 December 2024.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-01-09	Available
Change Memo 0920-1317 December 2024.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-01-09	Repair queued
D. Explanation for Program Changes or Adjustments.docx	Supplementary Document	Uploaded 2024-10-29	Available
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	Available
G2. Privacy Impact Assessment.pdf	Supplementary Document	Uploaded 2024-10-29	Missing upstream
G1. Privacy Impact Assessment.pdf	Supplementary Document	Uploaded 2024-10-29	Available
G1. Privacy Impact Assessment.pdf	Supplementary Document	Uploaded 2024-10-29	Repair queued
G. Privacy Impact Assessment.pdf	Supplementary Document	Uploaded 2024-10-29	Available
G. Privacy Impact Assessment.pdf	Supplementary Document	Uploaded 2024-10-29	Repair queued
E3. Human Subjects Determination.pdf	Supplementary Document	Uploaded 2024-10-29	Available
E3. Human Subjects Determination.pdf	Supplementary Document	Uploaded 2024-10-29	Repair queued
B. FRN-60 day.pdf	Supplementary Document	Uploaded 2024-10-29	Available
B. FRN-60 day.pdf	Supplementary Document	Uploaded 2024-10-29	Missing upstream
SSB 0920-1317 NHSN COVID-19_FINAL.docx	Supporting Statement B	Uploaded 2024-10-29	Available
SSB 0920-1317 NHSN COVID-19_FINAL.docx	Supporting Statement B	Uploaded 2024-10-29	Missing upstream
SSA 0920-1317 NHSN COVID 08JAN2025.docx	Supporting Statement A	Uploaded 2025-03-04	Available
SSA 0920-1317 NHSN COVID 08JAN2025.docx	Supporting Statement A	Uploaded 2025-03-04	Missing upstream
Change Memo 0920-1317 August 2024_FINAL_v2.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2024-08-22	Available
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	Available
Change Memo 0920-1317.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2024-08-06	Missing upstream
Change Request Memo NHSN COVID-19 0920-1317_26APR2024 v2.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2024-04-26	Available
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	Available
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	Available
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
TOI-Facility Importing COVID-19 and Respiratory Infections using a .csv file_RIFC.docx	Supplementary Document	Uploaded 2023-09-07	Missing upstream
Change Memo for NHSN September 2023_0920_1317.docx	Justification for No Material/Nonsubstantive Change	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	Available
Crosswalk_57.218.docx	Supplementary Document	Uploaded 2023-09-07	Repair queued
Crosswalk_57.144.docx	Supplementary Document	Uploaded 2023-09-07	Available
Crosswalk_57.144.docx	Supplementary Document	Uploaded 2023-09-07	Missing upstream
Crosswalk-COVID-19 Hospital Data.docx	Supplementary Document	Uploaded 2023-09-07	Available
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	Available
Crosswalk 11.4 updated COVID JUNE_final.docx	Supplementary Document	Uploaded 2023-05-18	Missing upstream
Change Memo for NHSN May 2023_0920_1317_final.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2023-05-18	Available
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	Available
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	Available
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	Available
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	Available
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	Available
1c. 42 USC 242m.PDF	Supplementary Document	Uploaded 2022-11-28	Missing upstream
1b. 42 USC 242k.PDF	Supplementary Document	Uploaded 2022-11-28	Available
1b. 42 USC 242k.PDF	Supplementary Document	Uploaded 2022-11-28	Repair queued
1a. 42 USC 242b.PDF	Supplementary Document	Uploaded 2022-11-28	Available
1a. 42 USC 242b.PDF	Supplementary Document	Uploaded 2022-11-28	Missing upstream

IC Document Collections

IC ID	Collection	Type	Status
271955	57.510 COVID–19 Module Dialysis Outpatient Facility-CSV	Form and Instruction	Unchanged
271955	57.510 COVID–19 Module Dialysis Outpatient Facility-CSV	Form and Instruction	Unchanged
271950	57.509 Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities-.CSV	Form and Instruction	Unchanged
271950	57.509 Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities-.CSV	Form and Instruction	Unchanged
271948	57.221 Healthcare Personnel COVID-19 Person Level Vaccination-Healthcare Personnel Safety Component_CSV	Form and Instruction	Removed
271948	57.221 Healthcare Personnel COVID-19 Person Level Vaccination-Healthcare Personnel Safety Component_CSV	Form and Instruction	Removed
271947	57.221 Healthcare Personnel COVID-19 Person Level Vaccination-Healthcare Personnel Safety Component_Manual	Form and Instruction	Removed
271947	57.221 Healthcare Personnel COVID-19 Person Level Vaccination-Healthcare Personnel Safety Component_Manual	Form and Instruction	Removed
271946	57.221 Healthcare Personnel COVID-19 Person Level Vaccination-LTC Component_CSV	Form and Instruction	Removed
271946	57.221 Healthcare Personnel COVID-19 Person Level Vaccination-LTC Component_CSV	Form and Instruction	Removed
271945	57.221 Healthcare Personnel COVID-19 Person Level Vaccination-LTC Component _Manual	Form and Instruction	Removed
271945	57.221 Healthcare Personnel COVID-19 Person Level Vaccination-LTC Component _Manual	Form and Instruction	Removed
271943	57.220 Weekly Person Level Respiratory Pathogen and Vaccination for Residents-LTCF Component_CSV	Form and Instruction	Removed
271943	57.220 Weekly Person Level Respiratory Pathogen and Vaccination for Residents-LTCF Component_CSV	Form and Instruction	Removed
271941	57.220 Weekly Person Level Respiratory Pathogen and Vaccination for Residents-LTCF Component_Manual	Form and Instruction	Removed
271941	57.220 Weekly Person Level Respiratory Pathogen and Vaccination for Residents-LTCF Component_Manual	Form and Instruction	Removed
271935	57.155 Point of Care Testing Results - CSV	Form and Instruction	Modified
271935	57.155 Point of Care Testing Results - CSV	Form and Instruction	Modified
270333	Weekly Healthcare Personnel COVID-19 Vaccination Cumulative Summary (.csv)	Form and Instruction	Unchanged
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
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
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
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
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
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
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
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
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
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
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
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
266012	57.155 Point of Care Testing Results - Manual	Form and Instruction	Modified
249436	57.509 Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities_Manual	Form and Instruction	Unchanged
249436	57.509 Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities_Manual	Form and Instruction	Unchanged
249435	Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities (manual)	Form and Instruction	Unchanged
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
249434	Weekly Healthcare Personnel COVID-19 Vaccination Cumulative Summary (manual)	Form and Instruction	Unchanged
243719	57.510 COVID–19 Module Dialysis Outpatient Facility_Manual	Form and Instruction	Unchanged
243719	57.510 COVID–19 Module Dialysis Outpatient Facility_Manual	Form and Instruction	Unchanged
243698	57.140 NHSN and Secure Access Management Services (SAMS) enrollment	Form and Instruction	Unchanged
243698	57.140 NHSN and Secure Access Management Services (SAMS) enrollment	Form and Instruction	Unchanged

ICR Details

Status	Active
Agency/Subagency	HHS/CDC
OMB Control No	0920-1317
Type of Information Collection	No material or nonsubstantive change to a currently approved collection
Previous ICR Reference No	202501-0920-003
Agency Tracking No	0920-25-0025
Date Submitted to OIRA	2025-03-28
Requested Expiration Date	1969-12-31