Hospital-Acquired Condition Reduction Program-NHSN HAI Measures Validation

Quality Measures and Administrative Procedures for the Hospital-Acquired Condition Reduction Program (CMS-10668)

Documents and Forms

Document Name Document Type
Form CMS-10668 Hospital-Acquired Condition Reduction Program-NHSN HAI Measures Validation Form and Instruction
CMS-10668 Cauti Validation Template FY27_CAUTI_ValTemp.xlsx Form and Instruction
CMS-10668 CDI Validation Template FY27_CDI_ValTemp.xlsx Form and Instruction
CMS-10668 CLABSI Validation Template FY27_CLABSI_ValTemp.xlsx Form and Instruction
CMS-10668 MRSA Validation Template FY27_MRSA_ValTemp.xlsx Form and Instruction
CMS-10668 Measure Exception Form for Healthcare-Associated Infecti FY26-IPPS-MeasureExceptionForm06132025.pdf Form and Instruction
CMS-10668 CMS Hospital-Acquired Condition (HAC) Reduction Program CY24-HACRP-ValidReconReqForm06132025.pdf Form and Instruction
FY26-HACRP-PRA-Crosswalk-1.pdf Crosswalk IC Document

Information Collection (IC) Details

IC Title:	Hospital-Acquired Condition Reduction Program-NHSN HAI Measures Validation	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10668	Cauti Validation Template	FY27_CAUTI_ValTemp.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10668	CDI Validation Template	FY27_CDI_ValTemp.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10668	CLABSI Validation Template	FY27_CLABSI_ValTemp.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10668	MRSA Validation Template	FY27_MRSA_ValTemp.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10668	Measure Exception Form for Healthcare-Associated Infection (HAI) Data	FY26-IPPS-MeasureExceptionForm06132025.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10668	CMS Hospital-Acquired Condition (HAC) Reduction Program Validation Review for Reconsideration Request	CY24-HACRP-ValidReconReqForm06132025.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 640	Number of Respondents for Small Entity: 360

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	640	640
Annual IC Time Burden (Hours)	28,840	28,840
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Crosswalk	FY26-HACRP-PRA-Crosswalk-1.pdf	06/17/2025

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.