Information Collection Request

The AHRQ Safety Program for Healthcare Associated Infection Prevention

ICR 202506-0935-002 · OMB unassigned · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 5 Clinical Outcomes Data Template Form New Repair queued
Form 5 Clinical Outcomes Data Form New Repair queued
Form 4 VAP VAE Gap Analysis Form and Instruction New Repair queued
Form 4 CAUTI Gap Analysis Form and Instruction New Available
Form 4 CLABSI Gap Analysis Form and Instruction New Repair queued
Form 4 Gap Analysis Form and Instruction New Repair queued
Form 3 VAP VAE Monthly Device Rounds Checklist Form and Instruction New Available
Form 3 CAUTI Monthly Device Rounds Checklist Form and Instruction New Available
Form 3 CLABSI Monthly Device Rounds Checklist Form and Instruction New Available
Form 3 CUSP Device Rounds Form and Instruction New Missing upstream
Form 2 HSOPS Form and Instruction New Repair queued
Form 2 HSOPS Form and Instruction New Repair queued
Form 1 Semi-Structured Interview Guide Form and Instruction New Available
Form 1 Semi-Structured Interview Guide Form and Instruction New Repair queued
Response to APIC letter 60-day FRN _2.27.25.pdf Supplementary Document Uploaded 2025-08-07 Available
SSA_AHRQ Safety Program for HAI Prevention_NEW_FINAL - OMB_NORC CLEAN_08.05.25.docx Supporting Statement A Uploaded 2025-08-07 Available
SSA_AHRQ Safety Program for HAI Prevention_NEW_FINAL.docx Supporting Statement A Uploaded 2025-06-23 Repair queued
Attachment L - Draft Schedule of Evaluation Activities.docx Supplementary Document Uploaded 2025-06-23 Available
Attachment L - Draft Schedule of Evaluation Activities.docx Supplementary Document Uploaded 2025-06-23 Repair queued
Attachment J - Submission Guide for Clinical Outcomes Data Collection.docx Supplementary Document Uploaded 2025-06-23 Repair queued
Attachment J - Submission Guide for Clinical Outcomes Data Collection.docx Supplementary Document Uploaded 2025-06-23 Repair queued
Attachment I - Clinical Outcomes Data Template.docx Supplementary Document Uploaded 2025-06-23 Repair queued
Attachment I - Clinical Outcomes Data Template.docx Supplementary Document Uploaded 2025-06-23 Repair queued
Attachment H - VAP VAE Gap Analysis_v2.docx Supplementary Document Uploaded 2025-06-23 Available
Attachment H - VAP VAE Gap Analysis_v2.docx Supplementary Document Uploaded 2025-06-23 Repair queued
Attachment G - CAUTI Gap Analysis.docx Supplementary Document Uploaded 2025-06-23 Repair queued
Attachment G - CAUTI Gap Analysis.docx Supplementary Document Uploaded 2025-06-23 Repair queued
Attachment F - CLABSI Gap Analysis.docx Supplementary Document Uploaded 2025-06-23 Repair queued
Attachment F - CLABSI Gap Analysis.docx Supplementary Document Uploaded 2025-06-23 Missing upstream
Attachment E - VAP VAE Monthly Device Rounds Checklist.docx Supplementary Document Uploaded 2025-06-23 Repair queued
Attachment E - VAP VAE Monthly Device Rounds Checklist.docx Supplementary Document Uploaded 2025-06-23 Repair queued
Attachment D - CAUTI Monthly Device Rounds Checklist.docx Supplementary Document Uploaded 2025-06-18 Available
Attachment D - CAUTI Monthly Device Rounds Checklist.docx Supplementary Document Uploaded 2025-06-18 Repair queued
Attachment C - CLABSI Monthly Device Rounds Checklist.docx Supplementary Document Uploaded 2025-06-17 Available
Attachment C - CLABSI Monthly Device Rounds Checklist.docx Supplementary Document Uploaded 2025-06-17 Repair queued
Attachment B - AHRQ HSOPS.docx Supplementary Document Uploaded 2025-06-17 Available
Attachment B - AHRQ HSOPS.docx Supplementary Document Uploaded 2025-06-17 Missing upstream
Attachment A - Semi-structured Interview Guide.docx Supplementary Document Uploaded 2025-06-17 Available
Attachment A - Semi-structured Interview Guide.docx Supplementary Document Uploaded 2025-06-17 Repair queued
AHRQ Safety Program for HAI Prevention_Public Comment.docx Public Comments Uploaded 2025-01-21 Repair queued
SSB_AHRQ Safety Program for HAI Prevention_NEW_FINAL.docx Supporting Statement B Uploaded 2025-06-17 Repair queued
SSB_AHRQ Safety Program for HAI Prevention_NEW_FINAL.docx Supporting Statement B Uploaded 2025-06-17 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
275885 Clinical Outcomes Data Form NewClinical Outcomes Data Template
275885 Clinical Outcomes Data Form New
275885 Clinical Outcomes Data Instruction New
275883 Gap Analysis Form and Instruction NewVAP VAE Gap Analysis
275883 Gap Analysis Form and Instruction NewCAUTI Gap Analysis
275883 Gap Analysis Form and Instruction NewCLABSI Gap Analysis
275883 Gap Analysis Form and Instruction New
275882 CUSP Device Rounds Form and Instruction NewVAP VAE Monthly Device Rounds Checklist
275882 CUSP Device Rounds Form and Instruction NewCAUTI Monthly Device Rounds Checklist
275882 CUSP Device Rounds Form and Instruction NewCLABSI Monthly Device Rounds Checklist
275882 CUSP Device Rounds Form and Instruction New
275881 HSOPS Form and Instruction NewHSOPS
275881 HSOPS Form and Instruction New
275877 Semi-Structured Interview Guide Form and Instruction NewSemi-Structured Interview Guide
275877 Semi-Structured Interview Guide Form and Instruction New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
08/31/2028 36 Months From Approved
3,800 0 0
2,469 0 0
0 0 0





Reginfo record details
5
table that charts list of burden
IC Title Form No. Form Name
CUSP Device Rounds 3, 3, 3 ,   ,  
Clinical Outcomes Data 5
Gap Analysis 4, 4, 4 ,   ,  
HSOPS 2
Semi-Structured Interview Guide 1

table that charts list of burden
  Total Approved 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 3,800 0 0 3,800 0 0
Annual Time Burden (Hours) 2,469 0 0 2,469 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No