Prevalence Survey of Healthcare Associated Infections (HAIs) and Antimicrobial Use in U.S. Acute Care Hospitals

Forms and Documents

Document Name	Status
Patient Information Form (PIF) Form	Modified
Healthcare Facility Assessment (HFA) Form	Modified
AttachmentK_FINAL_0920-0852_2014PrescribingQualityForms_20140718.pdf Supplementary Document	2014-07-21
AttachmentJ_FINAL_0920-0852_2014EIPHFA_20140718.pdf Supplementary Document	2014-07-21
NonsubChange_0920-0852_SuppStateB_v9_20140718.docx Justification for No Material/Nonsubstantive Change	2014-07-21
NonsubChange_0920-0852_SuppStateA_v9_20140721.doc Justification for No Material/Nonsubstantive Change	2014-07-21
Reinstatement_0920-0852_SuppStateB_v5_20130821.docx Supporting Statement B	2013-09-25
AttachmentI_FINAL_0920-0852_NonResearchDeterm.pdf Supplementary Document	2013-09-25
AttachmentH_FINAL_0920-0852_ NCHSConsultation.rtf Supplementary Document	2013-09-25
AttachmentI_ FINAL_0920-0852_InformationalDocument.pdf Supplementary Document	2013-09-25
AttachmentG_FINAL_0920-0852_SupplementalForms_20130726.docx Supplementary Document	2013-09-25
AttachmentF_FINAL_0920-0852_PTInstructions_v1_20130620.pdf Supplementary Document	2013-09-25
AttachmentB_FINAL_0920-0852_60 day published.pdf Supplementary Document	2013-09-25
AttachmentC_FINAL_0920-0852_ARRA_20130618.docx Supplementary Document	2013-09-25
Attachment A 42 USC 241.pdf Supplementary Document	2013-09-25
Reinstatement_0920-0852_SuppStateA_v6_20130923.doc Supporting Statement A	2013-09-25

IC Document Collections

IC ID	Document Title	Status
212404	Provision of Patient Lists Instruction	New
192452	Patient Information Form (PIF) Form	Modified
192451	Healthcare Facility Assessment (HFA) Form	Modified

ICR Details

OMB Control No: 0920-0852	ICR Reference No: 201407-0920-009
Status: Historical Inactive	Previous ICR Reference No: 201310-0920-002
Agency/Subagency: HHS/CDC	Agency Tracking No: 20565
Title: Prevalence Survey of Healthcare Associated Infections (HAIs) and Antimicrobial Use in U.S. Acute Care Hospitals
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: Improperly submitted and continue	Conclusion Date: 07/22/2014
	Date Received in OIRA: 07/22/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2016	12/31/2016	12/31/2016
Responses	21,500	0	21,500
Time Burden (Hours)	6,325	0	6,325
Cost Burden (Dollars)	0	0	0

---

Abstract: This resubmission of a request for change to perform a more limited data collection in 2014 and a full scale survey in 2015 due to funding availability.

---

Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act
   PL: Pub.L. 111 - 5 1 Name of Law: American Recovery and Reinvestment Act of 2009
  

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:
	77 FR 71798	12/04/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 59700	09/27/2013
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
Provision of Patient Lists
Healthcare Facility Assessment (HFA)	none	Healthcare Facility Assessment
Patient Information Form (PIF)	none	Patient Information Form

---

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: This change request is to perform a limited data collection in 2014 and the full scale survey in 2015 due to the late availability of funds. Burden for the provision of patient lists is added and the number of responses to the patient information form were reduced by half.

---

Annual Cost to Federal Government: $1,382,732

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? 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)? Yes

Is this ICR related to the Pandemic Response? Uncollected

---

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: 07/22/2014

---