Information Collection

Gap Analysis

IC 275883 under ICR 202506-0935-002 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 4 Gap Analysis	Form and Instruction
Form 4 CLABSI Gap Analysis Gap Analysis	Form and Instruction
Form 4 CAUTI Gap Analysis Gap Analysis	Form and Instruction
Form 4 VAP VAE Gap Analysis Gap Analysis	Form and Instruction
4 CLABSI Gap Analysis Attachment F - CLABSI Gap Analysis.docx	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 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
4 VAP VAE Gap Analysis Attachment H - VAP VAE Gap Analysis_v2.docx	Form and Instruction

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:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	4	Yes	Yes	Fillable Fileable
Form and Instruction	4	Yes	Yes	Fillable Fileable
Form and Instruction	4	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 %

table that charts list of burden
	Approved	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

table that charts IC Documents
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.

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