View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

Hospital-Acquired Condition Reduction Program-NHSN HAI Measures Validation
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10668 Cauti Validation Template FY27_CAUTI_ValTemp.xlsx Yes Yes Fillable Fileable
Form and Instruction CMS-10668 CDI Validation Template FY27_CDI_ValTemp.xlsx Yes Yes Fillable Fileable
Form and Instruction CMS-10668 CLABSI Validation Template FY27_CLABSI_ValTemp.xlsx Yes Yes Fillable Fileable
Form and Instruction CMS-10668 MRSA Validation Template FY27_MRSA_ValTemp.xlsx Yes Yes Fillable Fileable
Form and Instruction CMS-10668 Measure Exception Form for Healthcare-Associated Infection (HAI) Data FY26-IPPS-MeasureExceptionForm06132025.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10668 CMS Hospital-Acquired Condition (HAC) Reduction Program Validation Review for Reconsideration Request CY24-HACRP-ValidReconReqForm06132025.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

640 360
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 640 0 0 0 0 640
Annual IC Time Burden (Hours) 28,840 0 0 0 0 28,840
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Crosswalk FY26-HACRP-PRA-Crosswalk-1.pdf 06/17/2025
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.