Request for change 2.23.2021

Change Memo for

“National Healthcare Safety Network (NHSN) Patient Impact Module

Surveillance in Healthcare Facilities”

(OMB Control No. 0920-0666)

Expiration Date: 11/30/2024

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: February 8, 2021

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 Safety Component Surveillance in Healthcare Facilities (OMB Control No. 0920-0666).”

CDC is revising the NHSN Facility Administrator Change Request Form (CDC 57.104)

in the NHSN Patient Safety Component. This is a web-based form located on the NHSN webpage at https://www.cdc.gov/nhsn/facadmin/. This form will be modified to add an entry asking if the incoming Facility Administrator has Secure Access Management Services (SAMS) access or not with ‘Yes’ and ‘No’ radio buttons. Having this information will help the NHSN user support team better assist incoming Facility Administrators who do not have SAMS access because they can start the SAMS enrollment process once the change request form is received. We estimate no additional burden for this minor change to the form.

Type of Respondent	Form Name	No. of Respondents	No. Responses per Respondent	Avg. Burden per response (in hrs.)	Total Burden (in hrs.)
Microbiologist	57.104 NHSN Facility Administrator Change Request Form	800	1	5/60	67