5-Step Enrollment for Long-term Acute Care Facilities
Step 1: Training and Preparation
57.150 Patient Safety Component—Annual Facility Survey for LTAC January 2016 [PDF
- 312 KB]
Table of instructions for Patient Safety Annual Facility Survey for LTAC (CDC 57.150) [PDF - 152 KB]
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Time to complete step 1: 2 hours, 45 minutes
Step 2: Register
Agree to Rules of Behavior and register facility with NHSN using CMS Certification Number (CCN) or CDC assigned enrollment ID.
Time to complete step 2: 10 minutes
After registration, you will receive two emails: ‘Welcome to NHSN!’
arrives from NHSN immediately and ‘Invitation to Register’
arrives from SAMS-no-reply within 24 hours.
Step 3a: Register with SAMS
From the ‘Invitation to Register’ email, log in to SAMS with your username (i.e., email address) and temporary password provided. Accept the SAMS Rules of Behavior and complete the online SAMS registration form.
Time to complete step 3a: 16 minutes
Within 24 hours of successful online registration,
receive SAMS ‘Identity Verification Request’ email.
Step 3b: Complete and Submit Identity Proofing Verification
From the ‘Identity Verification Request’ email, print the Identity Verification Form, complete it, and take it to a notary public for endorsement. Fax the form and supporting documentation to CDC. You will receive ‘SAMS Account Activation’ and ‘SAMS Activity Authorization’ emails when your access is approved.
To access SAMS, you must receive your SAMS grid card, which will be delivered to your home address via U.S. mail within 14-21 days of your SAMS approval email. If you do not receive your grid card within 21 days, please contact email@example.com for assistance.
Time to complete step 3b: 35 minutes
Step 4: Submit NHSN Forms Electronically
Log in to SAMS using your password and SAMS grid card and select ‘NHSN Enrollment.’ Submit required NHSN forms online, including facility contact information.
Time to complete step 4: 32 minutes
Immediately after submitting forms, receive NHSN email,
subject "NHSN facility enrollment submitted."
Step 5: Sign and Send Consent
Using the above NHSN email, open, print, and sign the consent form. Ensure two signatures are on the form and fax to CDC.
Tip: To open the consent form, you may need to log in to SAMS using your grid card and password, and then copy and paste the link into that browser window.
Time to complete step 5: 10 minutes
Within 3 business days, receive NHSN email, subject ‘NHSN enrollment approved.’
Congratulations, enrollment is complete!
- Page last reviewed: February 26, 2015
- Page last updated: August 17, 2016
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