OMB Control No: 0920-1317
ICR Reference No:
202509-0920-004
Status: Received in OIRA
Previous ICR Reference No: 202502-0920-015
Agency/Subagency: HHS/CDC
Agency Tracking No:
0920-25-0176
Title: [NCEZID] National Healthcare
Safety Network (NHSN) Coronavirus (COVID-19) Surveillance in
Healthcare Facilities
Type of Information Collection: No
material or nonsubstantive change to a currently approved
collection
Common Form ICR: No
Type of Review Request: Regular
Date Submitted to OIRA:
09/30/2025
Requested
Previously Approved
Expiration Date
01/31/2028
01/31/2028
Responses
3,323,021
3,381,437
Time Burden (Hours)
1,558,384
1,585,369
Cost Burden (Dollars)
0
0
Abstract: The goal of this information
collection is to 1) capture the daily, aggregate impact of COVID-19
on healthcare facilities, and 2) monitor medical capacity to
respond at local, state, and national levels. This information will
be used to inform the overall real-time COVID-19 response efforts
and possible resource allocation, and enable state and local health
departments to gain immediate access to the COVID-19 data for
healthcare facilities within their jurisdiction. This Change
Request is submitted for 0920-01317 to update forms, following
revised ACIP vaccine recommendations for COVID-19. There is a net
decrease in burden hours associated with this Change
Request.
Authorizing Statute(s): US Code:
42 USC 242b, k, m Name of Law: U.S. Public Health Service Act
(PHSA)
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:
89 FR
47962
06/04/2024
30-day Notice:
Federal Register Citation:
Citation Date:
89 FR
84146
10/21/2024
Did the Agency receive public comments on
this ICR?
Yes
Number of Information Collection (IC) in this
ICR: 21
IC Title
Form No.
Form Name
57.101 Hospital
Respiratory Data Form (Weekly - .csv import)
0920-1317
Hospital
Respiratory Data Weekly Reporting Form
57.101 Hospital
Respiratory Data Form (Weekly - API)
0920-1317
Hospital
Respiratory Data Weekly Reporting Form
57.101 Hospital
Respiratory Data Form (Weekly - User Entry)
0920-1317
Hospital
Respiratory Data Weekly Reporting Form
57.102 - Hospital
Respiratory Data Fomr (Daily - API)
57.102
Hospital
Respiratory Data Daily Reporting Form 14AUG2024
57.102 - Hospital
Respiratory Data Form (Daily - user entry)
57.102
Hospital
Respiratory Data Daily Reporting Form 14AUG2024
57.102 Hospital
Respiratory Data Form (Daily - .csv import)
57.102
Hospital
Respiratory Data Daily Reporting Form 14AUG2024
57.140 NHSN and Secure
Access Management Services (SAMS) enrollment
0920-1317
NHSN Registration
Form
57.155 Point of Care
Testing Results - CSV
57.155
Point of Care
Testing Results
57.155 Point of Care
Testing Results - Manual
57.155
Point of Care
Testing Results
57.509 Weekly Patient
COVID-19 Vaccination Cumulative Summary for Dialysis
Facilities-.CSV
57.509
57.509 Weekly
COVID-19 Vaccination Cumulative Summary for Dialysis
Patients_CSV
57.509 Weekly Patient
COVID-19 Vaccination Cumulative Summary for Dialysis
Facilities_Manual
57.509
Weekly COVID-19
Vaccination Cumulative Summary for Dialysis
Patients_Manual
57.510 COVID–19 Module
Dialysis Outpatient Facility-CSV
57.510
57.510 COVID–19
Module Dialysis Outpatient Facility-.csv
57.510 COVID–19 Module
Dialysis Outpatient Facility_Manual
57.510
COVID–19 Module -
Dialysis Outpatient Facility
Optional Person Level
Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel
(.csv)
57.217, 57.217
Optional Person
Level Reporting of Weekly COVID-19 Vaccination for Healthcare
Personnel , Optional Person Level
Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel
29SEP2025
Optional Person Level
Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel
(manual)
57.217, 57.217
Optional Person
Level Reporting of Weekly COVID-19 Vaccination for Healthcare
Personnel , Optional Person Level
Reporting of Weekly COVID-19 Vaccination for Healthcare
Personnel_29SEP2025
Optional Person Level
Reporting of Weekly COVID-19 Vaccination for Long-Term Care
Residents (.csv)
57.216, 57.216
Optional Person
Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care
Residents , Optional Person Level
Reporting of Weekly COVID-19 Vaccination for Long-Term Care
Residents Form 57.216_rev 29SEP2025
Optional Person Level
Reporting of Weekly COVID-19 Vaccination for Long-Term Care
Residents (manual)
57.216, 57.216
Optional Person
Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care
Residents , Optional Person Level
Reporting of Weekly COVID-19 Vaccination for Long-Term Care
Residents Form 57.216_rev 29SEP2025
Weekly Healthcare
Personnel COVID-19 Vaccination Cumulative Summary (.csv)
57.219, 57.219
Healthcare
Personnel COVID-19 Vaccination Cumulative Summary ,
57.219 Healthcare
Personnel COVID-19 Vaccination Cumulative
Summary_25SEP2025
Weekly Healthcare
Personnel COVID-19 Vaccination Cumulative Summary (manual)
57.219, 57.219
Healthcare
Personnel COVID-19 Vaccination Cumulative Summary ,
57.219 Healthcare
Personnel COVID-19 Vaccination Cumulative Summary
Weekly Resident
COVID-19 Vaccination Cumulative Summary for Long-Term Care
Facilities (.csv)
57.218, 57.218, 57.218
Weekly Respiratory
Pathogen and Vaccination Summary for Residents of Long-Term Care
Facilities , Weekly Respiratory Pathogen
and Vaccination Summary for Residents of LTCF (.csv) ,
57.218 Weekly
Respiratory Pathogen and Vaccination Summary for Residents of
LTCF_25SEP2025
Weekly Resident
COVID-19 Vaccination Cumulative Summary for Long-Term Care
Facilities (manual)
57.218, Form 57.218, 57.218
Weekly Respiratory
Pathogen and Vaccination Summary for Residents of Long-Term Care
Facilities (manual) , Weekly Respiratory Pathogen
and Vaccination Summary for Residents of LTCF (manual) ,
57.218 Weekly
Respiratory Pathogen and Vaccination Summary for Residents of
LTCF_25SEP2025
ICR Summary of Burden
Total Request
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in
Estimate
Change Due to Potential Violation of
the PRA
Annual Number of Responses
3,323,021
3,381,437
0
-58,416
0
0
Annual Time Burden (Hours)
1,558,384
1,585,369
0
-26,985
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
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: Change Request for 0920-1317
includes modifications to four (4) forms. There is a net decrease
in overall burden.
Annual Cost to Federal Government:
$49,992,135
Does this IC contain surveys, censuses, or employ
statistical methods? Yes Part B of Supporting Statement
Does this ICR request any personally identifiable
information (see OMB Circular No. A-130 for an
explanation of this term)? Please consult with your agency's
privacy program when making this determination.
Yes
Does this ICR include a form that requires a Privacy Act
Statement (see 5
U.S.C. §552a(e)(3) )? Please consult with your agency's privacy
program when making this determination.
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)? No
Is this ICR related to the Pandemic Response?
Yes
Agency Contact: Jeffrey Zirger 404 639-7118
wtj5@cdc.gov