Gap Analysis

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

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

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	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

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	Previously Approved
Annual Number of Responses for this IC	934	934
Annual IC Time Burden (Hours)	934	934
Annual IC Cost Burden (Dollars)	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.