Federal Register / Vol. 88, No. 160 / Monday, August 21, 2023 / Notices 56827 

benchmarking to national data); private 

research and action organizations 

focused on men’s and women’s health, 

child well-being, and marriage and the 

family; academic researchers in the 

social and public health sciences; 

journalists, and many others. 

This submission requests approval for 

a revision to NSFG data collection for 

three years. The revision request 

includes the increase of the main survey 

incentive from $40 to $60, a small set 

of questionnaire revisions beginning in 

Year 3 (2024) data collection and to 

conduct several methodological studies 

designed to improve the efficiency and 

validity of NSFG data collection for the 

purposes described above. The total 

estimated annualized time burden to 

respondents is 6,584 hours. There is no 

cost to respondents other than their 

time. 

ESTIMATED ANNUALIZED BURDEN HOURS

Respondents Form Number of 

responses 

Responses 

per 

respondent 

Average 

burden/ 

response 

(in hours) 

Household member ......................................... Screener Interview ......................................... 15,000 1 5/60 

Household Female 15–49 years of age ......... Female Interview ............................................ 2,750 1 75/60 

Household Male 15–49 years of age ............. Male Interview ................................................ 2,250 1 50/60 

Household member ......................................... Screener Verification ...................................... 230 1 2/60 

Household Individual 15–49 years of age ...... Main Verification ............................................. 150 1 5/60 

Jeffrey M. Zirger, 

Lead, Information Collection Review Office, 

Office of Public Health Ethics and 

Regulations, Office of Science, Centers for 

Disease Control and Prevention. 

[FR Doc. 2023–17920 Filed 8–18–23; 8:45 am] 

BILLING CODE 4163–18–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Disease Control and 

Prevention 

[60Day–23–0666; Docket No. CDC–2023– 

0068] 

Proposed Data Collection Submitted 

for Public Comment and 

Recommendations 

AGENCY: Centers for Disease Control and 

Prevention (CDC), Department of Health 

and Human Services (HHS). 

ACTION: Notice with comment period. 

SUMMARY: The Centers for Disease 

Control and Prevention (CDC), as part of 

its continuing effort to reduce public 

burden and maximize the utility of 

government information, invites the 

general public and other Federal 

agencies the opportunity to comment on 

a continuing information collection, as 

required by the Paperwork Reduction 

Act of 1995. This notice invites 

comment on a proposed information 

collection project titled National 

Healthcare Safety Network (NHSN). 

NHSN provides facilities, States, 

regions, and the nation with data 

necessary to identify problem areas, 

measure the progress of prevention 

efforts, and ultimately eliminate 

healthcare-associated infections (HAIs) 

nationwide. 

DATES: CDC must receive written 

comments on or before October 20, 

2023. 

ADDRESSES: You may submit comments, 

identified by Docket No. CDC–2023– 

0068 by either of the following methods: 

• Federal eRulemaking Portal: 

ww.regulations.gov. Follow the 

instructions for submitting comments. 

• Mail: Jeffrey M. Zirger, Information 

Collection Review Office, Centers for 

Disease Control and Prevention, 1600 

Clifton Road NE, MS H21–8, Atlanta, 

Georgia 30329. 

Instructions: All submissions received 

must include the agency name and 

Docket Number. CDC will post, without 

change, all relevant comments to 

www.regulations.gov. 

Please note: Submit all comments 

through the Federal eRulemaking portal 

(www.regulations.gov) or by U.S. mail to 

the address listed above. 

FOR FURTHER INFORMATION CONTACT: To 

request more information on the 

proposed project or to obtain a copy of 

the information collection plan and 

instruments, contact Jeffrey M. Zirger, 

Information Collection Review Office, 

Centers for Disease Control and 

Prevention, 1600 Clifton Road NE, MS 

H21–8, Atlanta, Georgia 30329; 

Telephone: 404–639–7570; Email: omb@

cdc.gov. 

SUPPLEMENTARY INFORMATION: Under the 

Paperwork Reduction Act of 1995 (PRA) 

(44 U.S.C. 3501–3520), Federal agencies 

must obtain approval from the Office of 

Management and Budget (OMB) for each 

collection of information they conduct 

or sponsor. In addition, the PRA also 

requires Federal agencies to provide a 

60-day notice in the Federal Register 

concerning each proposed collection of 

information, including each new 

proposed collection, each proposed 

extension of existing collection of 

information, and each reinstatement of 

previously approved information 

collection before submitting the 

collection to the OMB for approval. To 

comply with this requirement, we are 

publishing this notice of a proposed 

data collection as described below. 

The OMB is particularly interested in 

comments that will help: 

1. Evaluate whether the proposed 

collection of information is necessary 

for the proper performance of the 

functions of the agency, including 

whether the information will have 

practical utility; 

2. Evaluate the accuracy of the 

agency’s estimate of the burden of the 

proposed collection of information, 

including the validity of the 

methodology and assumptions used; 

3. Enhance the quality, utility, and 

clarity of the information to be 

collected; 

4. Minimize the burden of the 

collection of information on those who 

are to respond, including through the 

use of appropriate automated, 

electronic, mechanical, or other 

technological collection techniques or 

other forms of information technology, 

e.g., permitting electronic submissions 

of responses; and 

5. Assess information collection costs. 

Proposed Project 

National Healthcare Safety Network 

(NHSN) (OMB Control No. 0920–0666, 

Exp. 6/30/2026)—Revision—National 

Center for Emerging and Zoonotic 

Infection Diseases (NCEZID), Centers for 

Disease Control and Prevention (CDC). 

Background and Brief Description 

The Division of Healthcare Quality 

Promotion (DHQP), National Center for 

Emerging and Zoonotic Infectious 


ddrumheller on DSK120RN23PROD with NOTICES1
56828 Federal Register / Vol. 88, No. 160 / Monday, August 21, 2023 / Notices 

Diseases (NCEZID), Centers for Disease 

Control and Prevention (CDC) collects 

data from healthcare facilities in the 

National Healthcare Safety Network 

(NHSN) (OMB Control No. 0920–0666). 

NHSN provides facilities, States, 

regions, and the nation with data 

necessary to identify problem areas, 

measure the progress of prevention 

efforts, and ultimately eliminate 

healthcare-associated infections (HAIs) 

nationwide. NHSN allows healthcare 

facilities to track blood safety errors and 

various healthcare-associated infection 

prevention practice methods such as 

healthcare personnel influenza vaccine 

status and corresponding infection 

control adherence rates. NHSN 

currently has seven components: Patient 

Safety (PS), Healthcare Personnel Safety 

(HPS), Biovigilance (BV), Long-Term 

Care Facility (LTCF), Outpatient 

Procedure (OPC), Dialysis, and Neonatal 

Component. 

Data reported under the PS 

Component are used to determine the 

magnitude of the healthcare-associated 

adverse events and trends in the rates of 

the events, in the distribution of 

pathogens, and in the adherence to 

prevention practices. Data will help 

detect changes in the epidemiology of 

adverse events resulting from new 

medical therapies and changing patient 

risks. Additionally, reported data is 

being used to describe the epidemiology 

of antimicrobial use and resistance and 

to better understand the relationship of 

antimicrobial therapy to this rising 

problem. Under the HPS Component, 

protocols and data on events—both 

positive and adverse—are used to 

determine: (1) the magnitude of adverse 

events in healthcare personnel; and (2) 

compliance with immunization and 

sharps injuries safety guidelines. Under 

the BV Component, data on adverse 

reactions and incidents associated with 

blood transfusions are reported and 

analyzed to provide national estimates 

of adverse reactions and incidents. 

Under the LTCF Component, data is 

captured from skilled nursing facilities. 

Reporting methods under the LTCF 

component have been created by using 

forms from the PS Component as a 

model with modifications to specifically 

address the specific characteristics of 

LTCF residents and the unique data 

needs of these facilities reporting into 

NHSN. The Respiratory Tract Infection 

Form (RTI)—will not to be used by 

NHSN users, but as part of an EIP 

project with four EIP sites. The Form is 

titled Denominators for Healthcare 

Associated Infections (HAIs): 

Respiratory Tract Infections. The 

purpose of this form is to allow testing 

prior to introducing a new module and 

forms to NHSN users. The CDC’s 

Epidemiology Research & Innovations 

Branch (ERIB) team will use the form to 

perform field testing of variables to 

explore the utilization, applicability, 

and data collection burden associated 

with these variables. This process will 

inform areas of improvement prior to 

incorporating the new module, 

including protocol, forms, and 

instructions into NHSN. The Dialysis 

Component offers a simplified user 

interface for dialysis users to streamline 

their data entry and analysis processes 

as well as provide options for expanding 

in the future to include dialysis 

surveillance in settings other than 

outpatient facilities. The Outpatient 

Procedure Component (OPC) gathers 

data on the impact of infections and 

outcomes related to operative 

procedures performed in Ambulatory 

Surgery Centers (ASCs). The OPC is 

used to monitor two event types: Same 

Day Outcome Measures and Surgical 

Site Infections (SSIs). The Neonatal 

Component focuses on premature 

neonates and the healthcare associated 

events that occur as a result of their 

prematurity. This component currently 

has one module, which includes Late 

Onset-Sepsis and Meningitis. NHSN has 

increasingly served as the operating 

system for HAI reporting compliance 

through legislation established by the 

States. As of July 2023, 37 States, the 

District of Columbia and the City of 

Philadelphia, Pennsylvania have opted 

to use NHSN as their primary system for 

mandated reporting. Reporting 

compliance is completed by healthcare 

facilities in their respective 

jurisdictions, with emphasis on those 

States and municipalities acquiring 

varying consequences for failure to use 

NHSN. Additionally, healthcare 

facilities in five U.S. territories (Puerto 

Rico, American Samoa, the U.S. Virgin 

Islands, Guam, and the Northern 

Mariana Islands) are voluntarily 

reporting to NHSN. Additional 

territories are projected to follow with 

similar use of NHSN for reporting 

purposes. NHSN’s data is used to aid in 

the tracking of HAIs and guide infection 

prevention activities/practices that 

protect patients. The Centers for 

Medicare and Medicaid Services (CMS) 

and other payers use these data to 

determine incentives for performance at 

healthcare facilities across the U.S. and 

surrounding territories, and members of 

the public may use some protected data 

to inform their selection among 

available providers. Each of these 

parties is dependent on the 

completeness and accuracy of the data. 

CDC and CMS work closely and are 

fully committed to ensuring complete 

and accurate reporting, which are 

critical for protecting patients and 

guiding national, State, and local 

prevention priorities. CMS collects 

some HAI data and healthcare personnel 

influenza vaccination summary data, 

which is done on a voluntary basis as 

part of its Fee-for-Service Medicare 

quality reporting programs, while others 

may report data required by a Federal 

mandate. Facilities that fail to report 

quality measure data are subject to 

partial payment reduction in the 

applicable Medicare Fee-for-Service 

payment system. CMS links their 

quality reporting to payment for 

Medicare-eligible acute care hospitals, 

inpatient rehabilitation facilities, longterm acute care facilities, oncology 

hospitals, inpatient psychiatric 

facilities, dialysis facilities, and 

ambulatory surgery centers. Facilities 

report HAI data and healthcare 

personnel influenza vaccination 

summary data to CMS via NHSN as part 

of CMS’s quality reporting programs to 

receive full payment. Still, many 

healthcare facilities, even in States 

without HAI reporting legislation, 

submit limited HAI data to NHSN 

voluntarily. NHSN’s data collection 

updates continue to support the 

incentive programs managed by CMS. 

For example, survey questions support 

requirements for CMS’ quality reporting 

programs. Additionally, CDC has 

collaborated with CMS on a voluntary 

National Nursing Home Quality 

Collaborative, which focuses on 

recruiting nursing homes to report HAI 

data to NHSN and to retain their 

continued participation. 

The NHSN data collection was 

previously approved in June of 2023 for 

6,209,922 responses and 1,693,215 

annual burden hours. The proposed 

changes in this Revision include 

modifications to 15 existing data 

collection forms and one new form. CDC 

requests OMB approval for an estimated 

annual burden 1,524,039 hours. There is 

no cost to respondents other than their 

time to participate. 


ddrumheller on DSK120RN23PROD with NOTICES1
Federal Register / Vol. 88, No. 160 / Monday, August 21, 2023 / Notices 56829 

ESTIMATED ANNUALIZED BURDEN HOURS

Form number & name Number of 

respondents 

Number of 

responses per 

respondent 

Average 

burden per 

response 

(min./hour) 

Total burden 

(hours) 

57.100 NHSN Registration Form ..................................................................... 2,000 1 5/60 167 

57.101 Facility Contact Information ................................................................. 2,000 1 10/60 333 

57.103 Patient Safety Component—Annual Hospital Survey ......................... 5,311 1 135/60 11,950 

57.104 Facility Administrator Change Request Form ..................................... 800 1 5/60 67 

57.105 Group Contact Information .................................................................. 1,000 1 5/60 83 

57.106 Patient Safety Monthly Reporting Plan ............................................... 6,387 12 15/60 19,161 

57.108 Primary Bloodstream Infection (BSI) ................................................... 5,775 5 38/60 18,288 

57.111 Pneumonia (PNEU) ............................................................................. 1,800 2 30/60 1800 

57.112 Ventilator-Associated Event ................................................................ 5,463 8 28/60 20,395 

57.113 Pediatric Ventilator-Associated Event (PedVAE) ................................ 334 1 30/60 167 

57.114 Urinary Tract Infection (UTI) ................................................................ 6,000 5 20/60 10,000 

57.115 Custom Event ...................................................................................... 600 91 35/60 31,850 

57.116 Denominators for Neonatal Intensive Care Unit (NICU) ..................... 1,100 12 4/60 880 

57.117 Denominators for Specialty Care Area (SCA)/Oncology (ONC) ......... 500 12 5/60 500 

57.118 Denominators for Intensive Care Unit (ICU)/Other locations (not 

NICU or SCA) .............................................................................................. 5,500 60 5/60 27,500 

57.120 Surgical Site Infection (SSI) ................................................................ 6,000 9 35/60 31,500 

57.121 Denominator for Procedure ................................................................. 6,000 602 10/60 602,000 

57.122 HAI Progress Report State Health Department Survey ...................... 55 1 28/60 26 

57.123 Antimicrobial Use and Resistance (AUR)-Microbiology Data Electronic Upload Specification Tables .............................................................. 5,500 12 5/60 5,500 

57.124 Antimicrobial Use and Resistance (AUR)-Pharmacy Data Electronic 

Upload Specification Tables ........................................................................ 5,500 12 5/60 5,500 

57.125 Central Line Insertion Practices Adherence Monitoring ...................... 500 213 25/60 44,375 

57.126 MDRO or CDI Infection Form .............................................................. 720 11 30/60 3,960 

57.127 MDRO and CDI Prevention Process and Outcome Measures Monthly Monitoring ................................................................................................. 5,500 29 15/60 39,875 

57.128 Laboratory-identified MDRO or CDI Event .......................................... 4,800 79 20/60 126,400 

57.129 Adult Sepsis ......................................................................................... 50 250 25/60 5,208 

57.135 Late Onset Sepsis/Meningitis Denominator Form: Data Table for 

monthly electronic upload ............................................................................ 300 6 5/60 150 

57.136 Late Onset Sepsis/Meningitis Event Form: Data Table for Monthly 

Electronic Upload ......................................................................................... 300 6 5/60 150 

57.137 Long-Term Care Facility Component—Annual Facility Survey ........... 17,700 1 122/60 35,990 

57.138 Laboratory-identified MDRO or CDI Event for LTCF .......................... 1,086 24 20/60 8,688 

57.139 MDRO and CDI Prevention Process Measures Monthly Monitoring 

for LTCF ....................................................................................................... 1,019 12 20/60 4,076 

57.140 Urinary Tract Infection (UTI) for LTCF ................................................ 339 36 35/60 7,119 

57.141 Monthly Reporting Plan for LTCF ........................................................ 1,099 12 15/60 3,297 

57.142 Denominators for LTCF Locations ...................................................... 714 12 35/60 4,998 

57.143 Prevention Process Measures Monthly Monitoring for LTCF ............. 357 12 5/60 357 

57.150 LTAC Annual Survey ........................................................................... 392 1 89/60 581 

57.151 Rehab Annual Survey ......................................................................... 1,160 1 89/60 1,721 

57.200 Healthcare Personnel Safety Component Annual Facility Survey ...... 50 1 480/60 400 

57.204 Healthcare Worker Demographic Data ............................................... 50 200 20/60 3,333 

57.205 Exposure to Blood/Body Fluids ........................................................... 50 50 60/60 2,500 

57.206 Healthcare Worker Prophylaxis/Treatment .......................................... 50 30 15/60 375 

57.207 Follow-Up Laboratory Testing ............................................................. 50 50 15/60 625 

57.210 Healthcare Worker Prophylaxis/Treatment-Influenza .......................... 50 50 10/60 417 

57.300 Hemovigilance Module Annual Survey ................................................ 500 1 85/60 708 

57.301 Hemovigilance Module Monthly Reporting Plan ................................. 500 12 60/60 6,000 

57.303 Hemovigilance Module Monthly Reporting Denominators .................. 500 12 70/60 7,000 

57.305 Hemovigilance Incident ....................................................................... 500 10 10/60 833 

57.306 Hemovigilance Module Annual Survey—Non-acute care facility ........ 500 1 35/60 292 

57.307 Hemovigilance Adverse Reaction—Acute Hemolytic Transfusion Reaction ............................................................................................................ 500 4 20/60 667 

57.308 Hemovigilance Adverse Reaction—Allergic Transfusion Reaction ..... 500 4 20/60 667 

57.309 Hemovigilance Adverse Reaction—Delayed Hemolytic Transfusion 

Reaction ....................................................................................................... 500 1 20/60 167 

57.310 Hemovigilance Adverse Reaction—Delayed Serologic Transfusion 

Reaction ....................................................................................................... 500 2 20/60 333 

57.311 Hemovigilance Adverse Reaction—Febrile Non-hemolytic Transfusion Reaction ............................................................................................ 500 4 20/60 667 

57.312 Hemovigilance Adverse Reaction—Hypotensive Transfusion Reaction ................................................................................................................ 500 1 20/60 167 

57.313 Hemovigilance Adverse Reaction—Infection ...................................... 500 1 20/60 167 

57.314 Hemovigilance Adverse Reaction—Post Transfusion Purpura ........... 500 1 20/60 167 

57.315 Hemovigilance Adverse Reaction—Transfusion Associated Dyspnea 500 1 20/60 167 

57.316 Hemovigilance Adverse Reaction—Transfusion Associated Graft vs. 

Host Disease ................................................................................................ 500 1 20/60 167 


ddrumheller on DSK120RN23PROD with NOTICES1
56830 Federal Register / Vol. 88, No. 160 / Monday, August 21, 2023 / Notices 

ESTIMATED ANNUALIZED BURDEN HOURS—Continued 

Form number & name Number of 

respondents 

Number of 

responses per 

respondent 

Average 

burden per 

response 

(min./hour) 

Total burden 

(hours) 

57.317 Hemovigilance Adverse Reaction—Transfusion Related Acute Lung 

Injury ............................................................................................................. 500 1 20/60 167 

57.318 Hemovigilance Adverse Reaction—Transfusion Associated Circulatory Overload ......................................................................................... 500 2 20/60 333 

57.319 Hemovigilance Adverse Reaction—Unknown Transfusion Reaction .. 500 1 20/60 167 

57.320 Hemovigilance Adverse Reaction—Other Transfusion Reaction ........ 500 1 20/60 167 

57.400 Outpatient Procedure Component—Annual Facility Survey ............... 350 1 10/60 117 

57.401 Outpatient Procedure Component—Monthly Reporting Plan ............. 350 12 15/60 1,050 

57.402 Outpatient Procedure Component Same Day Outcome Measures .... 50 1 40/60 33 

57.403 Outpatient Procedure Component—Monthly Denominators for Same 

Day Outcome Measures .............................................................................. 50 400 40/60 13,333 

57.404 Outpatient Procedure Component—SSI Denominator ........................ 300 100 10/60 5,000 

57.405 Outpatient Procedure Component—Surgical Site (SSI) Event ........... 300 36 35/60 6,300 

57.500 Outpatient Dialysis Center Practices Survey ...................................... 7,400 1 125/60 15,417 

57.501 Dialysis Monthly Reporting Plan .......................................................... 7,400 12 5/60 7,400 

57.502 Dialysis Event ...................................................................................... 7,400 30 27/60 99,900 

57.503 Denominator for Outpatient Dialysis .................................................... 7,400 24 10/60 29,600 

57.504 Prevention Process Measures Monthly Monitoring for Dialysis .......... 1,730 12 75/60 25,950 

57.505 Dialysis Patient Influenza Vaccination ................................................. 615 50 10/60 5,125 

57.506 Dialysis Patient Influenza Vaccination Denominator ........................... 615 5 10/60 3075 

57.507 Home Dialysis Center Practices Survey ............................................. 450 1 36/60 270 

Weekly Healthcare Personnel Influenza Vaccination Cumulative Summary 

for Non-Long-Term Care Facilities ............................................................... 125 52 60/60 6,500 

Weekly Healthcare Personnel Influenza Vaccination Cumulative Summary 

for Long-Term Care Facilities ...................................................................... 1,200 52 60/60 62,400 

Weekly Resident Influenza Vaccination Cumulative Summary for Long-Term 

Care Facilities .............................................................................................. 2,500 52 60/60 130,000 

Annual Healthcare Personnel Influenza Vaccination Summary ...................... 5,000 1 120/60 10,000 

Healthcare-facility onset, antibiotic-treated Clostridioides difficile (C. difficile) 

Infection (HT–CDI) Event Module Annual Reporting Plan .......................... 7,821 1 10/60 1,304 

Total Estimated Annual Burden Hours ..................................................... ........................ ........................ ........................ 1,524,039 

Jeffrey M. Zirger, 

Lead, Information Collection Review Office, 

Office of Public Health Ethics and 

Regulations, Office of Science, Centers for 

Disease Control and Prevention. 

[FR Doc. 2023–17924 Filed 8–18–23; 8:45 am] 

BILLING CODE 4163–18–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Disease Control and 

Prevention 

Solicitation of Nominations for 

Appointment to the Board of Scientific 

Counselors, National Center for Health 

Statistics 

AGENCY: Centers for Disease Control and 

Prevention (CDC), Department of Health 

and Human Services (HHS). 

ACTION: Notice. 

SUMMARY: The Centers for Disease 

Control and Prevention (CDC), within 

the Department of Health and Human 

Services (HHS), is seeking nominations 

for membership on the Board of 

Scientific Counselors, National Center 

for Health Statistics (BSC, NCHS). The 

BSC, NCHS consists of up to 15 experts 

including the Chair in fields associated 

with the scientific and technical 

program objectives of the Center. 

DATES: Nominations for membership on 

the BSC, NCHS will be accepted on a 

rolling basis. To be considered for the 

upcoming nomination slate, 

submissions should be received no later 

than September 22, 2023. Submissions 

received after this time will not be 

considered for the current membership 

cycle. 

ADDRESSES: All nominations should be 

emailed to NCHS-BSCmail@cdc.gov. 

FOR FURTHER INFORMATION CONTACT: 

Rebecca Hines, M.H.S., Designated 

Federal Officer, Board of Scientific 

Counselors, National Center for Health 

Statistics, Centers for Disease Control 

and Prevention, 3311 Toledo Road, 

Mailstop P–08, Hyattsville, Maryland 

20782. Telephone: (301) 458–4715; 

Email: RSHines@cdc.gov. 

SUPPLEMENTARY INFORMATION: 

Nominations are sought for individuals 

who have the expertise and 

qualifications necessary to contribute to 

the accomplishment of the objective of 

the Board of Scientific Counselors, 

National Center for Health Statistics 

(BSC, NCHS) to provide advice and 

guidance on statistical and 

epidemiological research, data 

collection, and activities that support 

NCHS, such as: determinants of health; 

extent and nature of illness and 

disability, including life expectancy; 

incidence of various acute and chronic 

illnesses/impairments and accidental 

injuries; prevalence of chronic diseases 

and impairments; infant and maternal 

morbidity and mortality; nutrition 

status; environmental, social, and other 

hazards affecting health status; health 

resources associated with physician and 

dental visits, hospitalizations, nursing, 

extended care facilities, home health 

agencies, and other health institutions; 

utilization of health care in a broad 

array of settings; trends in prices/costs 

and sources of payments; federal, state, 

and local government expenditures for 

health care services; the relationship 

between demographic and 

socioeconomic characteristics and 

health characteristics; family formation, 

growth, and dissolution; new or 

improved methods for obtaining current 

data on the aforementioned factors; data 

security and confidentiality and 


ddrumheller on DSK120RN23PROD with NOTICES1