Information Collection Request

The AHRQ Safety Program for Methicillin-Resistant Staphylococcus aureus (MRSA) Prevention

ICR 202107-0935-003 · OMB 0935-0260 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 11 Attachment L: Clinical Outcomes Data for LTC Form and Instruction New Missing upstream
Form 10 Attachment K: Clinical Outcomes Data for Surgical Services Form and Instruction New Repair queued
Form 9 Attachment J: Clinical Outcomes Data for ICU/Non-ICU Form and Instruction New Repair queued
Form 11 Attachment L: Clinical Outcomes Data for LTC Form and Instruction New Repair queued
Form 10 Attachment K: Clinical Outcomes Data for Surgical Services Form and Instruction New Repair queued
Form 9 Attachment J: Clinical Outcomes Data for ICU/Non-ICU Form and Instruction New Repair queued
Form 9 Attachment J: Clinical Outcomes Data for ICU/Non-ICU Form and Instruction New Missing upstream
Form 9 Attachment J: Clinical Outcomes Data for ICU/Non-ICU Form and Instruction New Repair queued
Form 8 TEAM CHECK-UP TOOL – Long-Term Care (LTC) Form and Instruction New Repair queued
Form 6 Team Checkup Tool Form and Instruction New Repair queued
Form 3 Gap Analysis Form and Instruction New Missing upstream
Form 2 Attachment I: Survey of Patient Safety Culture – NHSOPS Form and Instruction New Available
Form 1 Attachment H: Survey of Patient Safety Culture – HSOPS Form and Instruction New Available
Supporting Statement A eb rev_21.07.23.mam.docx Supporting Statement A Uploaded 2021-07-26 Available
Supporting Statement B.docx Supporting Statement B Uploaded 2021-07-23 Repair queued
Att P Schedule of Evaluation Activities.docx Supplementary Document Uploaded 2021-07-23 Repair queued
Att O Completion Guide for LTC Clinical Outcomes Data.docx Supplementary Document Uploaded 2021-07-23 Repair queued
Att N Completion Guide for Surgical Services Clinical Outcomes Data.docx Supplementary Document Uploaded 2021-07-23 Missing upstream
Att M Completion Guide for ICU-Non-ICU Clinical Outcomes Data.docx Supplementary Document Uploaded 2021-07-23 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
248521 Attachment L: Clinical Outcomes Data for LTC Form and Instruction New
248520 Attachment K: Clinical Outcomes Data for Surgical Services Form and Instruction New
248519 Attachment J: Clinical Outcomes Data for ICU/Non-ICU Form and Instruction New
248518 Attachment L: Clinical Outcomes Data for LTC Form and Instruction New
248517 Attachment K: Clinical Outcomes Data for Surgical Services Form and Instruction New
248516 Attachment J: Clinical Outcomes Data for ICU/Non-ICU Form and Instruction New
248515 Attachment J: Clinical Outcomes Data for ICU/Non-ICU Form and Instruction New
248507 Attachment J: Clinical Outcomes Data for ICU/Non-ICU Form and Instruction New
248495 TEAM CHECK-UP TOOL – Long-Term Care (LTC) Form and Instruction New
248492 Team Checkup Tool Form and Instruction New
248491 Gap Analysis Form and Instruction New
248489 Attachment I: Survey of Patient Safety Culture – NHSOPS Form and Instruction New
248486 Attachment H: Survey of Patient Safety Culture – HSOPS Form and Instruction New

ICR Details

Reginfo record details
table that charts list comparision
  Requested Previously Approved
36 Months From Approved
36,637 0
11,552 0
0 0





Reginfo record details
13
table that charts list of burden
IC Title Form No. Form Name
Attachment H: Survey of Patient Safety Culture – HSOPS 1 Attachment H: Survey of Patient Safety Culture – HSOPS
Attachment I: Survey of Patient Safety Culture – NHSOPS 2 2,500
Attachment J: Clinical Outcomes Data for ICU/Non-ICU 9 Attachment J: Clinical Outcomes Data for ICU/Non-ICU
Attachment J: Clinical Outcomes Data for ICU/Non-ICU 9 Attachment J: Clinical Outcomes Data for ICU/Non-ICU
Attachment J: Clinical Outcomes Data for ICU/Non-ICU 9 Attachment J: Clinical Outcomes Data for ICU/Non-ICU
Attachment J: Clinical Outcomes Data for ICU/Non-ICU 9 Attachment J: Clinical Outcomes Data for ICU/Non-ICU
Attachment K: Clinical Outcomes Data for Surgical Services 10 Attachment K: Clinical Outcomes Data for Surgical Services
Attachment K: Clinical Outcomes Data for Surgical Services 10 Attachment K: Clinical Outcomes Data for Surgical Services
Attachment L: Clinical Outcomes Data for LTC 11 Attachment L: Clinical Outcomes Data for LTC
Attachment L: Clinical Outcomes Data for LTC 11 Attachment L: Clinical Outcomes Data for LTC
Gap Analysis 3, 4, 5 Attachment B: ICU/Non-ICU Gap Analysis ,   Attachment C: Surgical Services Gap Analysis ,   Attachment D: LTC Gap Analysis
TEAM CHECK-UP TOOL – Long-Term Care (LTC) 8 Attachment G: LTC Team Checkup Tool
Team Checkup Tool 6, 7 Attachment E: ICU/Non-ICU Team Checkup Tool ,   Attachment F: Surgical Services Team Checkup Tool

table that charts list of burden
  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 36,637 0 0 36,637 0 0
Annual Time Burden (Hours) 11,552 0 0 11,552 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No