Gap Analysis

The AHRQ Safety Program for Healthcare Associated Infection Prevention

Documents and Forms

Document Name Document Type
Form 4 Gap Analysis Form and Instruction
4 CLABSI Gap Analysis Attachment F - CLABSI Gap Analysis.docx Form and Instruction
4 CAUTI Gap Analysis Attachment G - CAUTI Gap Analysis.docx Form and Instruction
4 VAP VAE Gap Analysis Attachment H - VAP VAE Gap Analysis_v2.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Gap Analysis	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	4	CLABSI Gap Analysis	Attachment F - CLABSI Gap Analysis.docx	Yes	Yes	Fillable Fileable
Form and Instruction	4	CAUTI Gap Analysis	Attachment G - CAUTI Gap Analysis.docx	Yes	Yes	Fillable Fileable
Form and Instruction	4	VAP VAE Gap Analysis	Attachment H - VAP VAE Gap Analysis_v2.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 200	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: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	400	400
Annual IC Time Burden (Hours)	400	400
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.