Change Memo for
“National Healthcare Safety Network (NHSN) Patient Impact Module for Coronavirus (COVID-19)
Surveillance in Healthcare Facilities”
(OMB Control No. 0920-1290)
Expiration Date: 09/30/2020
Program Contact
Lauren Wattenmaker
Surveillance Branch
Division of Healthcare Quality Promotion
National Center for Emerging and Zoonotic Infectious Diseases
Centers for Disease Control and Prevention
Atlanta, Georgia 30333
Phone: 404-718-5842
Email: nlh3@cdc.gov
Submission Date: May 7, 2020
The Centers for Disease Control and Prevention (CDC), Division of Healthcare Quality Promotion (DHQP) requests a nonmaterial/non-substantive of the currently approved Information Collection Request: “National Healthcare Safety Network (NHSN) Patient Impact Module for Coronavirus (COVID-19) Surveillance in Healthcare Facilities (OMB Control No. 0920-1290).”
This Change Request is submitted to include two additional revised versions of the following Instructions documents:
Instructions for Completion of the COVID-19 Long-term Care Facility (LTCF): Resident Impact and Facility Capacity Form (CDC 57.144)
Instructions for Completion of the COVID-19 Long-term Care Facility (LTCF): Staff and Personnel Impact Form (CDC 57.145)
Revisions contain a revised narrative that describes reporting requirements.
The burden associated with the retrospective data entry was included in earlier iterations of the ICR. Therefore there is no change to the burden requested with this Change Request.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Wattenmaker, Lauren (CDC/DDID/NCEZID/DHQP) |
| File Modified | 0000-00-00 |
| File Created | 2021-01-13 |