0920-1317 Change Request Memo_30SEP2025

Change Memo for

National Healthcare Safety Network (NHSN)

Surveillance in Healthcare Facilities

(OMB Control Nos. 0920-1317)

Expiration Date: 1/31/2028

Program Contact

Paula Farrell

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: 404-498-4019 

Email: ujb1@cdc.gov

Submission Date: September 23, 2025

The Centers for Disease Control and Prevention (CDC), Division of Healthcare Quality Promotion (DHQP) requests approval for non-substantive changes to four currently approved data collection instruments in the National Healthcare Safety Network (NHSN) Coronavirus (COVID-19) Surveillance in Healthcare Facilities (OMB Control No. 0920-1317).

We are requesting a determination of this review by September 30, 2025, as these revisions will go into effect on October 1, 2025, in time for data collection at the beginning of respiratory virus season.

These non-substantive changes are minor and do not constitute more than a 10% change to the original OMB package (0920-1317). The data collection for which approval for changes is being sought include:

1. 57.216 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents

2. 57.217 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel: Long Term Care Facilities Component and Healthcare Personnel Safety Component

3. 57.218 Weekly Respiratory Pathogen and Vaccination Summary for Residents of Long-Term Care Facilities

4. 57.219 Healthcare Personnel COVID-19 Vaccination Cumulative Summary

The changes to the currently approved instrument, including associated burden, are described below.

1. 57.216 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents

Form 57.216 collects resident level respiratory vaccination coverage data for nursing home residents. Data are submitted manually and/or via .CSV file upload (based on the facility’s preference). The changes are specifically to update the form in accordance with the updated recommendations for receipt of the COVID-19 vaccine. This request consists of adding an additional dose option to align with new recommendations.

For form 57.216 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents (manual), the No. of Respondents decreased from 1669 to 1071. Total burden decreased from 89,681 to 55692. Total cost increased from $5,255,303 to $3,263,551.

For form 57.216 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Long-Term Care Residents (.csv) the No. of Respondents decreased from 167 to 119. Total burden decreased from 8,973 to 6188. Total cost decreased from $507,001 to $349,622.

Type of Change	Changed To	Justification	Impact to Burden
Addition	Dose 11 Vaccine Manufacturer Name**	Additional dose added to align with the updated recommendations for receipt of the COVID-19 vaccine	No change
Addition	Dose 11 Vaccination Date**	Additional dose added to align with the updated recommendations for receipt of the COVID-19 vaccine	No change
Addition	Dose 11 Vaccine NDC Number	Additional dose added to align with the updated recommendations for receipt of the COVID-19 vaccine	No change
Addition	Dose 11 Vaccine NDC Number	Additional dose added to align with the updated recommendations for receipt of the COVID-19 vaccine	No change
Addition	Dose 11 Vaccine NDC Number	Additional dose added to align with the updated recommendations for receipt of the COVID-19 vaccine	No change

2. 57.217 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel: Long Term Care Facilities Component and Healthcare Personnel Safety Component

Form 57.217 collects person level respiratory vaccination coverage data for healthcare personnel at nursing homes and various other facility types. Data are submitted manually and/or via .CSV file upload (based on the facility’s preference). The changes are specifically to update the form in accordance with the updated recommendations for receipt of the COVID-19 vaccine. This request consists of adding an additional dose option to align with new recommendations.

For form 57.217 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel: Long Term Care Facilities Component and Healthcare Personnel Safety Component (manual), the No. of Respondents increased from 96 to 1159. The No. of Responses per Respondent decreased from 52 to 12.. Total burden increased from 5158 to 13908 . Total cost increased from $302,282 to $815,009.

For form 57.217 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel -Long Term Care Facilities Component and Healthcare Personnel Safety Component (.csv), the No. of Respondents decreased from 106 to 129. The No. of Responses per Respondent decreased from 52 to 12.. Total burden increased from 5696 to 1548. Total cost increased from $321,809 to $815009.

Type of Change	Changed To	Justification	Impact to Burden
Addition	Dose 11 Vaccine Manufacturer Name**	Additional dose added to align with the updated recommendations for receipt of the COVID-19 vaccine	No change
Addition	Dose 11 Vaccination Date**	Additional dose added to align with the updated recommendations for receipt of the COVID-19 vaccine	No change
Addition	Dose 11 Vaccine NDC Number	Additional dose added to align with the updated recommendations for receipt of the COVID-19 vaccine	No change
Addition	Dose 11 Vaccine NDC Number	Additional dose added to align with the updated recommendations for receipt of the COVID-19 vaccine	No change
Addition	Dose 11 Vaccine NDC Number	Additional dose added to align with the updated recommendations for receipt of the COVID-19 vaccine	No change

3. 57.218 Weekly Respiratory Pathogen and Vaccination Summary for Residents of Long-Term Care Facilities

Form 57.218 collects aggregate level respiratory pathogen and vaccination data for nursing home residents. Data are submitted manually and via .CSV files in the NHSN application (facility preference). The change is specifically to update the form in accordance with the updated recommendations for receipt of the COVID-19 vaccine. The change consists of updating verbiage to align with new recommendations.

For form 57.218 Weekly Respiratory Pathogen and Vaccination Summary for Residents of Long-Term Care Facilities (manual), the No. of Respondents decreased from 13,123 to 11,207. Total burden decreased from 384,332 to 242,818. Total cost decreased from $16,661,855 to $14,229,154.

For form 57.218 Weekly Respiratory Pathogen and Vaccination Summary for Residents of Long-Term Care Facilities (.csv), the No. of Responses per Respondent increased from 1526 to 1632. Total burden increased from 26,451 to28288. Total cost increased from $1,494,482 to $1,598,272.

Type of Change	Changed From	Changed To	Justification	Impact to Burden
Revision	2a. *Number of residents who are up to date with COVID-19 vaccines	2a. *Number of residents who received COVID-19 vaccine	Language update in accordance with the updated recommendations for receipt of the COVID-19 vaccine	No Change
Revision	3ai. **Number of residents in Question #3a who received the up to date COVID-19 vaccine 14 days or more before the positive test	3ai. **Number of residents in Question #3a who received the COVID-19 vaccine 14 days or more before the positive test	Language update in accordance with the updated recommendations for receipt of the COVID-19 vaccine	No Change
Revision	4ai. **Number of residents in Question #4a who received the up to date COVID-19 vaccine 14 days or more before the positive test	4ai. **Number of residents in Question #4a who received the COVID-19 vaccine 14 days or more before the positive test	Language update in accordance with the updated recommendations for receipt of the COVID-19 vaccine	No Change

4. 57.219 Healthcare Personnel COVID-19 Vaccination Cumulative Summary

Form 57.219 collects aggregate level respiratory pathogen and vaccination data for healthcare personnel at nursing homes and various other facility types. Data are submitted manually and via .CSV files in the NHSN application (facility preference). The change is specifically to update the form in accordance with the updated recommendations for receipt of the COVID-19 vaccine. The change consists of updating verbiage to align with new recommendations.

For form 57.219 Healthcare Personnel COVID-19 Vaccination Cumulative Summary (manual), the No. of Respondents increased from 11,360 to 13,328. Total burden increased from 102,240 to 119,952. Total cost increased from $5,991,264 to $7,029,187.

For form 57.219 Healthcare Personnel COVID-19 Vaccination Cumulative Summary (.csv), the No. of Respondents increased from 4107 to 7501. Total burden increased from 32,856 to 60008. Total cost increased from $1,856,364 to $3,390,452.

Type of Change	Changed From	Changed To	Justification	Impact to Burden
Revision	2. *Cumulative number of HCP in Question #1 who are up to date with COVID-19 vaccines	2. *Cumulative number of HCP in Question #1 who have received COVID-19 vaccine.	Language update in accordance with the updated recommendations for receipt of the COVID-19 vaccine	No change

Burden Estimates – 0920-1317

As a result of proposed changes to the form, the estimated annualized burden is expected to decrease by 26,984 hours, from 1,585,369 to 1,558,385.

Form No.	Form Name	No. of Respondents	No. of Responses per Respondent	Average Burden per Response (in minutes)	Total Burden Hours	Hourly Wage Rate	Total Respondent Costs	Type of Respondent
57.216	Person-Level Respiratory Pathogens Vaccination Form for Residents– LTCF Component (manual)	1071	52	60/60	55692	$58.60	$	Microbiologist
57.216	Person-Level Respiratory Pathogens Vaccination Form for Residents– LTCF Component (.csv)	119	52	60/60	6188	$56.50	$349,622	Information Technology
57.217	57.217 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel -Long Term Care Component and Healthcare Personnel Safety Component (manual)	1159	12	60/60	13908	$58.60	$815009	Microbiologist
57.217	57.217 Optional Person Level Reporting of Weekly COVID-19 Vaccination for Healthcare Personnel -Long Term Care Component and Healthcare Personal Safety Component (csv)	129	12	60/60	1548	$56.50	$87462	Information Technology
57.218	Weekly Respiratory Pathogen and Vaccination Summary for Residents of Long-Term Care Facilities (manual)	11207	52	25/60	242818	$58.60	$14,229,154	Microbiologist
57.218	Weekly Respiratory Pathogen and Vaccination Summary for Residents of Long-Term Care Facilities (csv)	1632	52	20/60	28288	$56.50	$1,598,272	Information Technology
57.219	Healthcare Personnel COVID-19 Vaccination Cumulative Summary (manual)-LTC and HPS	13328	12	45/60	119952	$58.60	$7029187	Microbiologist
57.219	Healthcare Personnel COVID-19 Vaccination Cumulative Summary (.csv)	7501	12	40/60	60008	$56.50	$3,390,452	Information Technology