OMB control number

[NCEZID] The National Healthcare Safety Network (NHSN)

OMB 0920-0666 · HHS/CDC.

OMB 0920-0666

The National Healthcare Safety Network (NHSN) is a system designed to accumulate, exchange, and integrate relevant information and resources among private and public stakeholders to support local and national efforts to protect patients and promote healthcare safety. Specifically, the data is used to determine the magnitude of various healthcare-associated adverse events and trends in the rates of these events among patients and healthcare workers with similar risks. The data will be used to detect changes in the epidemiology of adverse events resulting from new and current medical therapies and changing risks. This Revision contains minor changes to a few forms and minor burden changes.

The latest form for [NCEZID] The National Healthcare Safety Network (NHSN) expires 2029-03-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
57.106 Patient Safety Monthly Reporting Plan Form and Instruction
Claims Data - Initial IT Set-Up Other-data file
Patient Safety Component Digistal Measure Reporting Plan (RPS ONLY Daily FHIR Submission) - Yearly Maintenance Other-data file
Patient Safety Component Digistal Measure Reporting Plan (RPS ONLY Daily FHIR Submission) -IT Intial Set Up Other-data file
NHSNCoLab Pilot Site Technical Assessment Form and Instruction
NHSNCoLab Pilot Site Demographics Form and Instruction
NHSN FHIR Digital Quality Measures (dQMs) Form and Instruction
All Hazards Form and Instruction
Bed Capacity-IT Initial Set Up Form and Instruction
External Validation Summary Report Form and Instruction
Seasonal Survey on Influenza Vaccination Programs for Healthcare Personnel Form and Instruction
Annual Healthcare Personnel Influenza Vaccination Summary (CSV) Form
Weekly Healthcare Personnel Influenza Vaccination Cumulative Summary for Non-Long-Term Care Facilities (CSV) Form
Patient Safety Attestation Form and Instruction
57.130 Pathogens of High Consequence Form and Instruction
AUR Pharmacy Data Electronic Upload Specification Tables (Yearly Maintenance) Form
AUR Pharmacy Data Electronic Upload Specification Tables (Initial Set-up) Form
AUR Microbiolgy Data Electronic Upload Specification Tables (Yearly Maintenance) Form
AUR Microbiology Data Electronic Upload Specification Tables (Initial Set-up) Form
NHSN Help Desk Customer Satisfaction Survey Form and Instruction
Hemovigilance Module Monthly Incident Summary Form and Instruction
Billing Code Data: 837I Upload Form
57.701 - Glycemic Control Module-HYPO Annual Survey Form and Instruction
57.700 - Medication Safety Component FHIR Measure-Glycemic Control Module Hypoglycemia-Infection Preventionist Form and Instruction
57.700 - Medication Safety Component FHIR Measure-Glycemic Control Module Hypoglycemia-IT Yearly Maintenance Form and Instruction
57.700 - Medication Safety Component FHIR Measure-Glycemic Control Module Hypoglycemia-IT Initial Set up Form and Instruction
57.600 - Neonatal Component Late Onset Sepsis Meningitis (LOSMEN) Module CDA Data Collection-Infection Preventionist Form and Instruction
57.600 - Neonatal Component FHIR Measure-Late Onset Sepsis Meningitis (LOSMEN) Module-Infection Preventionist Form and Instruction
57.600 - Neonatal Component FHIR Measure-Late Onset Sepsis Meningitis (LOSMEN) Module-IT Yearly Maintenance Form and Instruction
57.600 - Neonatal Component FHIR Measure-Late Onset Sepsis Meningitis (LOSMEN) Module-IT Initial Set up Form and Instruction
57.145 - Long Term Care Antimicrobial Use (LTC-AU) Module CDA Form and Instruction
57.132 - Patient Safety Component FHIR Measures-HOB, HT-CDI Modules-Infection Preventionist Form and Instruction
57.132 - Patient Safety Component FHIR Measures-HOB, HT-CDI Modules-IT Yearly Maintenance Other-OMB Header and Burden Statement
57.132 - Patient Safety Component FHIR Measures-HOB, HT-CDI Modules-IT Initial Set up Other-OMB Header and Burden Statement
57.132 - Patient Safety Digital Reporting Plan (RPS CSV) Form and Instruction
Monthly Survey Patient Days & Nurse Staffing Form and Instruction
Annual Healthcare Personnel Influenza Vaccination Summary (manual) Form and Instruction
Weekly Healthcare Personnel Influenza Vaccination Cumulative Summary for Non-Long-Term Care Facilities Form and Instruction
Late Onset Sepsis/Meningitis Denominator Form: Data Table (Monthly) Form and Instruction
Late Onset Sepsis / Meningitis Event Form: Data Table for Monthly Electronic Upload Form and Instruction
57.104 NHSN Administrator Change Request Form Form and Instruction
57.122 HAI Progress Report State Health Department Survey Form
57.405 Outpatient Procedure Component - Surgical Site Infection (SSI) Event Form
57.404 Outpatient Procedure Component - SSI Denominators Form
57.507 Home Dialysis Center Practices Survey Form
57.320 Hemovigilance Adverse Reaction - Other Transfusion Reaction Form
57.319 Hemovigilance Adverse Reaction - Unknown Transfusion Reaction Form
57.318 Hemovigilance Adverse Reaction - Transfusion Associated Circulatory Overload Form
57.317 Hemovigilance Adverse Reaction - Transfusion Associated Acute Lung Injury Form
57.316 Hemovigilance Adverse Reaction - Transfusion Associated Graft vs. Host Disease Form
57.315 Hemovigilance Adverse Reaction - Transfusion Associated Dyspnea Form
57.314 Hemovigilance Adverse Reaction - Post Transfusion Purpura Form
57.313 Hemovigilance Adverse Reaction - Infection Form
57.312 Hemovigilance Adverse Reaction - Hypotensive Transfusion Reaction Form
57.311 Hemovigilance Adverse Reaction - Febrile Non-hemolytic Transfusion Reaction Form
57.310 Hemovigilance Adverse Reaction - Delayed Serologic Transfusion Reaction Form
57.309 Hemovigilance Adverse Reaction - Delayed Hemolytic Transfusion Reaction Form
57.308 Hemovigilance Adverse Reaction - Allergic Transfusion Reaction Form
57.307 Hemovigilance Adverse Reaction - Acute Hemolytic Transfusion Reaction Form
57.306 Hemovigilance Module Annual Facility Survey - Non-acute Care Facility Form
57.129_Adult Sepsis Form
57.115 Custom Event Form
57.113 Pediatric Ventilator-Associated Event (PedVAE) Form and Instruction
57.504 Prevention Process Measures Monthly Monitoring for Dialysis Form
57.501 Dialysis Monthly Reporting Plan Form
57.403 Outpatient Procedure Component - Monthly Denominators and Summary Form
57.402 Outpatient Procedure Component Event Form
57.401 Outpatient Procedure - Monthly Reporting Plan Form
57.400 Outpatient Procedure - Annual Facility Survey Form
57.151 Patient Safety Component -- Annual Facility Survey for IRF Form and Instruction
57.150 Patient Safety Component -- Annual Facility Survey for LTAC Form and Instruction
57.143 Prevention Process Measures Monthly Monitoring for LTCF Form
57.142 Denominators for LTCF Locations Form
57.141 Monthly Reporting Plan for LTCF Form
57.112 Ventilator-Associated Event (VAE) Form and Instruction
57.139 MDRO and CDI Prevention Process Measures Monthly for LTCF Form
57.138 Laboratory-Identified MDRO or CDI Event for LTCF Form
57.137 Long Term care Facility Component--Annual Facility Survey Form
57.305 Hemovigilance Incident Form
57.303 Hemovigilance Module Monthly Reporting Denominators Form and Instruction
57.301 Hemovigilance Module Monthly Reporting Plan Form and Instruction
57.300 Hemovigilance Module Annual Survey -- Acute Care Facility Form
57.105 Group Contact Information Form
57.140 Urinary Tract Infection (UTI) for LTCF Form and Instruction
57.103 Patient Safety Component - Annual Hospital Survey Form and Instruction
57.101 Facility Contact Information Form
57.124 Antimicrobial Use and Resistence (AUR) - Pharmacy Data Form and Instruction
57.123 Antimicrobial Use and Resistance (AUR) - Microbiology Data Upload Tables Form and Instruction
57.100 NHSN Registration Form Form
57.121 Denominators for Procedure Form and Instruction
57.128 Laboratory Identified or CDI MDRO Event Form
57.120 Surgical Site Infection (SSI) Form
57.126 MDRO or CDI Infection Event Form
57.503 Denominators for Outpatient Dialysis Form
57.127 MDRO and CDI Prevention Process and Outcome Measures Monthly Monitoring Form
57.118 Denominators for Intensive Care Unit (ICU) Other Locations (Not NICU or SCA) Form
57.117 Denominators for Specialty Care Area (SCA)/Onocology (ONC) Form
57.125 Central Line Insertion Practices Adherence Monitoring Form Form
57.116 Denominators for Neonatal Intensive Care Unit (NICU) Form
57.114 Urinary Tract Infection (UTI) Form and Instruction
57.111 Pneumonia (includes Any Patient Pneumonia flow Diagram and Infant and Children Pneumonia Flow Diagram) Form and Instruction
57.502 Dialysis Event Form and Instruction
57.108 Primary Bloodstream Infection (BSI) Form and Instruction
57.500 Outpatient Dialysis Center Practices Survey Form and Instruction

All Historical Document Collections

202603-0920-006	Revision of a currently approved collection	2026-03-13
202506-0920-018	Reinstatement with change of a previously approved collection	2025-06-30
202505-0920-007	No material or nonsubstantive change to a currently approved collection	2025-05-20
202502-0920-016	No material or nonsubstantive change to a currently approved collection	2025-03-28
202412-0920-019 Approved with change	Revision of a currently approved collection	2024-12-23
202412-0920-018 Withdrawn and continue	Revision of a currently approved collection	2024-12-20
202412-0920-016 Withdrawn and continue	Revision of a currently approved collection	2024-12-23
202410-0920-013	Revision of a currently approved collection	2024-11-15
202408-0920-016	No material or nonsubstantive change to a currently approved collection	2024-08-26
202402-0920-011 Approved without change	No material or nonsubstantive change to a currently approved collection	2024-02-28
202310-0920-013 Approved without change	Revision of a currently approved collection	2023-11-17
202301-0920-005 Approved with change	Revision of a currently approved collection	2023-04-26
202212-0920-013 Approved without change	Revision of a currently approved collection	2022-12-21
202112-0920-014 Approved with change	Revision of a currently approved collection	2022-01-03
202104-0920-002 Approved with change	No material or nonsubstantive change to a currently approved collection	2021-04-09
202102-0920-011 Approved without change	No material or nonsubstantive change to a currently approved collection	2021-02-23
202010-0920-016 Approved with change	Revision of a currently approved collection	2020-11-25
202006-0920-003 Approved with change	No material or nonsubstantive change to a currently approved collection	2020-06-04
201908-0920-004 Approved with change	Revision of a currently approved collection	2019-10-11
201808-0920-011 Approved with change	Revision of a currently approved collection	2018-10-11
201807-0920-002 Approved without change	No material or nonsubstantive change to a currently approved collection	2018-07-09
201801-0920-008 Approved without change	No material or nonsubstantive change to a currently approved collection	2018-01-31
201708-0920-029 Approved with change	Revision of a currently approved collection	2017-10-30
201607-0920-013 Approved with change	Revision of a currently approved collection	2016-08-17
201603-0920-007 Approved without change	No material or nonsubstantive change to a currently approved collection	2016-03-16
201508-0920-001 Approved with change	Revision of a currently approved collection	2015-09-11
201407-0920-007 Approved without change	Revision of a currently approved collection	2014-09-23
201308-0920-010 Approved without change	Revision of a currently approved collection	2013-08-28
201211-0920-005 Approved without change	Revision of a currently approved collection	2012-11-01
201112-0920-004 Approved without change	Revision of a currently approved collection	2011-12-08
201105-0920-001 Approved without change	Revision of a currently approved collection	2011-05-02
201104-0920-012 Improperly submitted and continue	Revision of a currently approved collection	2011-04-14
200908-0920-002 Approved without change	Revision of a currently approved collection	2009-08-19
200906-0920-001 Improperly submitted and continue	No material or nonsubstantive change to a currently approved collection	2009-06-08
200901-0920-009 Approved without change	No material or nonsubstantive change to a currently approved collection	2009-01-30
200801-0920-009 Approved without change	Revision of a currently approved collection	2008-01-30
200712-0920-003 Approved without change	No material or nonsubstantive change to a currently approved collection	2007-12-14
200701-0920-002 Withdrawn and continue	No material or nonsubstantive change to a currently approved collection	2007-01-12
200409-0920-012 Approved with change	New collection (Request for a new OMB Control Number)	2004-09-30