OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Survey of Healthcare-Associated Infections and Antimicrobial Use in U.S. Nursing Homes for use in Exploring the Development of a National Prevalence Model

OMB 0920-1165 · HHS/CDC.

OMB 0920-1165

Latest Forms, Documents, and Supporting Material

Document Name
Residents by Location Form Form and Instruction
Healthcare Facility Assessment Form and Instruction
Att. H - Information for NHs.docx Supplementary Document
Att. F2 - Supplemental Resident Antimicrobial Use Form.docx Supplementary Document
Att. F1 - Supplemental_Resident Infection Form.docx Supplementary Document
Att. E - Instructions Residents by Location Form.doc Supplementary Document
Att. C2 - Supplemental_Healthcare Facility Assessment Variables_EIP.docx Supplementary Document
Att. G -- Non-research determination.pdf Supplementary Document
HAI nursing home ICR_SuppStateA_OMB_r2.docx Supporting Statement A
Att. B - 60-day FRN.pdf Supplementary Document
Att. A - Section 301 of the Public Health Service Act (42 USC 241).pdf Supplementary Document
HAI nursing home ICR_SuppStateB_OMB_r1.docx Supporting Statement B
Residents by Location Form Form and Instruction
Healthcare Facility Assessment Form and Instruction

All Historical Document Collections

201605-0920-012

Approved with change

New collection (Request for a new OMB Control Number)

2016-06-03