View Information Collection Request (ICR) Package
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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0920-1317
ICR Reference No:
202205-0920-010
Status:
Historical Active
Previous ICR Reference No:
202109-0920-006
Agency/Subagency:
HHS/CDC
Agency Tracking No:
0920-1317
Title:
National Healthcare Safety Network (NHSN) Coronavirus (COVID-19) Surveillance in Healthcare Facilities
Type of Information Collection:
No material or nonsubstantive change to a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
05/26/2022
Retrieve Notice of Action (NOA)
Date Received in OIRA:
05/24/2022
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
01/31/2024
01/31/2024
01/31/2024
Responses
6,703,282
0
7,502,054
Time Burden (Hours)
3,989,389
0
4,736,898
Cost Burden (Dollars)
0
0
0
Abstract:
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 modify the Resident Impact and Facility Capacity and Staff and Personnel Impact Forms, and to remove the Supplies and Personal Protection Equipment Form from the collection. This results in an overall decrease in burden.
Authorizing Statute(s):
US Code:
42 USC 242b, k, m
Name of Law: The Public Health Service Act
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
85 FR 21443
04/17/2020
30-day Notice:
Federal Register Citation:
Citation Date:
85 FR 59313
09/21/2020
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
28
IC Title
Form No.
Form Name
Dialysis Component
0920-1317 / Form 57.510, 0920-20LW, 0920-1317, 0920-1317, 0920-1317 / Form 57.510
Dialysis Component
,
COVID-19 Module Dialysis Outpatient Facility
,
COVID-19 Module Dialysis Outpatient Facility Form 27MAY2021
,
COVID–19 Module - Dialysis Outpatient Facility
,
COVID–19 Module - Dialysis Outpatient Facility 25MAY2022
Healthcare Personnel Safety Monthly Reporting Plan - completed by Dialysis Facilities
0920-1317 / CDC Form 57.203
Healthcare Personnel Safety Monthly Reporting Plan
Healthcare Personnel Safety Monthly Reporting Plan - completed by Inpatient Psychiatric Facilities
0920-1317 / CDC Form 57.203
Healthcare Personnel Safety Monthly Reporting Plan
Monthly Reporting Plan form for Long-term Care Facilities
0920-1317 / CDC Form 57.141
Monthly Reporting Plan for LTCF
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, 0920-1317 / CDC 57.144
Resident Impact and Facility Capacity
,
Resident Impact and Facility Capacity
,
Resident Impact and Facility Capacity Form 23MAY2022
Resident Impact and Facility Capacity - Business and Financial Operations Occupations retrospective
CDC 57.144
Resident Impact and Facility Capacity
Resident Impact and Facility Capacity - LTCF Personnel
0920-1317 CDC 57.144, CDC 57.144, 0920-1317 Form 57.144, 0920-1317 / CDC 57.144
Resident Impact and Facility Capacity
,
Resident Impact and Facility Capacity
,
Resident Impact and Facility Capacity Form 21SEP2021
,
Resident Impact and Facility Capacity Form 23MAY2022
Resident Impact and Facility Capacity - LTCF Personnel retrospective
CDC 57.144
Resident Impact and Facility Capacity
Resident Impact and Facility Capacity - State and Local Health Dept Occupations
0920-1317 CDC 57.144, CDC 57.144, 0920-1317 / CDC 57.144
Resident Impact and Facility Capacity
,
Resident Impact and Facility Capacity
,
Resident Impact and Facility Capacity Form 23MAY2022
Resident Impact and Facility Capacity - State and Local Health Dept Occupations retrospective
CDC 57.144
Resident Impact and Facility Capacity
Resident Therapeutics - Business and Financial Operations 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 - State and Local Health Dept. Occupations
0920-1317 CDC 57.XXX
Long Term Care Facility: Resident Therapeutics
Staff and Personnel Impact - Business and Financial Operations Occupations
CDC 57.145, 0920-1317 / CDC 57.145
Staff and Personnel Impact
,
Staff and Personnel Impact Form 23MAY2022
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, 0920-1317 / CDC 57.145
Staff and Personnel Impact
,
Staff and Personnel Impact Form 23MAY2022
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, 0920-1317 / CDC 57.145
Staff and Personnel Impact
,
Staff and Personnel Impact Form 23MAY2022
Staff and Personnel Impact - State and Local Health Dept Occupations retrospective
CDC 57.145
Staff and Personnel Impact
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 - 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 - 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
VA - Resident COVID-19 Event Form - LTCF
0920-1317, 0920-1317
VA COVID-19 Resident Event Form
,
Resident COVID-19 Event Form 22SEP2021
VA - Staff and Personnel COVID-19 Event Form - LTCF
0920-1317, 0920-1317
VA - Staff and Personnel COVID-19 Event Form
,
Staff and Personnel COVID-19 Event Form 22SEP2021
Ventilator Capacity & Supplies - Business and Financial Operations Occupations
CDC 57.147
Ventilator Capacity & Supplies
Ventilator Capacity & Supplies - LCTF Personnel
CDC 57.147
Ventilator Capacity & Supplies
Ventilator Capacity & Supplies - State and Local Health Dept Occupations
CDC 57.147
Ventilator Capacity & Supplies
Weekly Healthcare Personnel COVID-19 Vaccination Cumulative Summary
0920-1317 / CDC Form 57.219
Healthcare Personnel COVID-19 Vaccination Cumulative Summary
Weekly Patient COVID-19 Vaccination Cumulative Summary for Dialysis Facilities
0920-1317 / CDC Form 57.509
Weekly COVID-19 Vaccination Cumulative Summary for Dialysis Patients
Weekly Resident COVID-19 Vaccination Cumulative Summary for Long-Term Care Facilities
0920-1317 / CDC Form 57.218
Weekly COVID-19 Vaccination Cumulative Summary for Residents of Long-Term Care Facilities
ICR Summary of Burden
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
6,703,282
7,502,054
0
-798,772
0
0
Annual Time Burden (Hours)
3,989,389
4,736,898
0
-747,509
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
Yes
Burden Reduction Due to:
Changing Forms
Short Statement:
Burden change due to modifications made to the following 0920-1317 Forms: Resident Impact and Facility Capacity Form Staff and Personnel Impact Form and Removal of: Supplies and PPE Form
Annual Cost to Federal Government:
$0
Does this IC contain surveys, censuses, or employ statistical methods?
No
Does this ICR request any personally identifiable information (see
OMB Circular No. A-130
for an explanation of this term)? Please consult with your agency's privacy program when making this determination.
Yes
Does this ICR include a form that requires a Privacy Act Statement (see
5 U.S.C. §552a(e)(3)
)? Please consult with your agency's privacy program when making this determination.
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
No
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
Yes
Agency Contact:
Jeffrey Zirger 404 639-7118 wtj5@cdc.gov
Common Form ICR:
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:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(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;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
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.
Certification Date:
05/24/2022
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