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Attachment K: Clinical Outcomes Data for Surgical Services
The AHRQ Safety Program for Methicillin-Resistant Staphylococcus aureus (MRSA) Prevention
OMB: 0935-0260
IC ID: 248520
OMB.report
HHS/AHRQ
OMB 0935-0260
ICR 202209-0935-004
IC 248520
( )
Documents and Forms
Document Name
Document Type
Form 10
Attachment K: Clinical Outcomes Data for Surgical Services
Form and Instruction
10 Attachment K: Clinical Outcomes Data for Surgical Servic
Att K Clinical Outcomes Data for Surgical Services.docx
Form and Instruction
10 Attachment K: Clinical Outcomes Data for Surgical Servic
Att K Clinical Outcomes Data for Surgical Services.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Attachment K: Clinical Outcomes Data for Surgical Services
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
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
10
Attachment K: Clinical Outcomes Data for Surgical Services
Att K Clinical Outcomes Data for Surgical Services.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:
50
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits, Not-for-profit institutions
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
300
0
180
0
0
120
Annual IC Time Burden (Hours)
150
0
90
0
0
60
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.