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Gap Analysis
The AHRQ Safety Program for Methicillin-Resistant Staphylococcus aureus (MRSA) Prevention
OMB: 0935-0260
IC ID: 248491
OMB.report
HHS/AHRQ
OMB 0935-0260
ICR 202209-0935-004
IC 248491
( )
Documents and Forms
Document Name
Document Type
Form 3
Gap Analysis
Form and Instruction
3 Attachment B: ICU/Non-ICU Gap Analysis
Att B ICU-Non-ICU Gap Analysis.docx
Form and Instruction
3 Attachment B: ICU/Non-ICU Gap Analysis
Att B ICU-Non-ICU Gap Analysis.docx
Form and Instruction
4 Attachment C: Surgical Services Gap Analysis
Att C Surgical Services Gap Analysis.docx
Form and Instruction
4 Attachment C: Surgical Services Gap Analysis
Att C Surgical Services Gap Analysis.docx
Form and Instruction
5 Attachment D: LTC Gap Analysis
Att D LTC Gap Analysis.docx
Form and Instruction
5 Attachment D: LTC Gap Analysis
Att D LTC Gap Analysis.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Gap Analysis
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
3
Attachment B: ICU/Non-ICU Gap Analysis
Att B ICU-Non-ICU Gap Analysis.docx
Yes
Yes
Fillable Fileable
Form and Instruction
4
Attachment C: Surgical Services Gap Analysis
Att C Surgical Services Gap Analysis.docx
Yes
Yes
Fillable Fileable
Form and Instruction
5
Attachment D: LTC Gap Analysis
Att D LTC Gap Analysis.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
467
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
934
0
0
0
0
934
Annual IC Time Burden (Hours)
934
0
0
0
0
934
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.