Attachment J: Clinical Outcomes Data for ICU/Non-ICU

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

Documents and Forms

Document Name Document Type
Form 9 Attachment J: Clinical Outcomes Data for ICU/Non-ICU Form and Instruction
9 Attachment J: Clinical Outcomes Data for ICU/Non-ICU Att J Clinical Outcomes Data for ICU-Non-ICU.docx Form and Instruction
9 Attachment J: Clinical Outcomes Data for ICU/Non-ICU Att J Clinical Outcomes Data for ICU-Non-ICU.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Attachment J: Clinical Outcomes Data for ICU/Non-ICU	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	9	Attachment J: Clinical Outcomes Data for ICU/Non-ICU	Att J Clinical Outcomes Data for ICU-Non-ICU.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 27	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	Previously Approved
Annual Number of Responses for this IC	27	27
Annual IC Time Burden (Hours)	135	135
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.