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Healthcare Facility Assessment (HFA)
Prevalence Survey of Healthcare Associated Infections (HAIs) and Antimicrobial Use in U.S. Acute Care Hospitals
OMB: 0920-0852
IC ID: 192451
OMB.report
HHS/CDC
OMB 0920-0852
ICR 202207-0920-011
IC 192451
( )
Documents and Forms
Document Name
Document Type
Healthcare Facility Assessment (HFA)
Form
Healthcare Facility Assessment (HFA) (modified August 20
Att_C_HFA._Aug22.docx
Form
Healthcare Facility Assessment (HFA) (modified August 20
Att_C_HFA._Aug22.docx
Form
Att_C_HFA_tracked_Aug22.docx
Healthcare Facility Assessment (HFA) (August 2022 edits in tracked-changes)
IC Document
Att_C_HFA_tracked_Aug22.docx
Healthcare Facility Assessment (HFA) (August 2022 edits in tracked-changes)
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Healthcare Facility Assessment (HFA)
Agency IC Tracking Number:
0920-0852
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
None
Healthcare Facility Assessment (HFA) (modified August 2022)
Att_C_HFA._Aug22.docx
Yes
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
100
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits, Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
50 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
100
0
0
0
0
100
Annual IC Time Burden (Hours)
75
0
0
0
0
75
Annual IC Cost Burden (Dollars)
2,652
0
0
0
0
2,652
Documents for IC
Title
Document
Date Uploaded
Healthcare Facility Assessment (HFA) (August 2022 edits in tracked-changes)
Att_C_HFA_tracked_Aug22.docx
08/02/2022
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.