Change Request Justification 12MAY2020

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:

1. Instructions for Completion of the COVID-19 Long-term Care Facility (LTCF): Resident Impact and Facility Capacity Form (CDC 57.144)

2. 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 increased as a result of the following modifications:

1. Burden required for NHSN enrollment

2. Burden required to find RETROSPECTIVE records related to:

   1. Staff and Personnel Impact

   2. Resident Impact / Facility Capacity

3. Burden required to enter RETROSPECTIVE data into NHSN via the calendaring function