OMB control number

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

OMB 0935-0260 · HHS/AHRQ.

OMB 0935-0260

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form 9.5 Attachment J - Subsequent data pull for 10% of units	Form and Instruction
Form 9.5 Attachment J - Subsequent data pull for 10% of units	Form and Instruction
Form 17 Attachment Q: Survey of Patient Safety Culture—HSOPS V.2	Form and Instruction
Form 17 Attachment Q: Survey of Patient Safety Culture-HSOPS V.2	Form and Instruction
Form 11 Attachment L: Clinical Outcomes Data for LTC	Form and Instruction
Form 11 Attachment L: Clinical Outcomes Data for LTC	Form and Instruction
Form 10 Attachment K: Clinical Outcomes Data for Surgical Services	Form and Instruction
Form 10 Attachment K: Clinical Outcomes Data for Surgical Services	Form and Instruction
Form 9 Attachment J: Clinical Outcomes Data for ICU/Non-ICU	Form and Instruction
Form 9 Attachment J: Clinical Outcomes Data for ICU/Non-ICU	Form and Instruction
Form 11 Attachment L: Clinical Outcomes Data for LTC	Form and Instruction
Form 11 Attachment L: Clinical Outcomes Data for LTC	Form and Instruction
Form 10 Attachment K: Clinical Outcomes Data for Surgical Services	Form and Instruction
Form 10 Attachment K: Clinical Outcomes Data for Surgical Services	Form and Instruction
Form 9 Attachment J: Clinical Outcomes Data for ICU/Non-ICU	Form and Instruction
Form 9 Attachment J: Clinical Outcomes Data for ICU/Non-ICU	Form and Instruction
Form 9 Attachment J: Clinical Outcomes Data for ICU/Non-ICU	Form and Instruction
Form 9 Attachment J: Clinical Outcomes Data for ICU/Non-ICU	Form and Instruction
Form 9 Attachment J: Clinical Outcomes Data for ICU/Non-ICU	Form and Instruction
Form 9 Attachment J: Clinical Outcomes Data for ICU/Non-ICU	Form and Instruction
Form 8 Attachment G: LTC Team Checkup Tool	Form and Instruction
Form 8 TEAM CHECK-UP TOOL – Long-Term Care (LTC)	Form and Instruction
Form 7 Attachment F: Surgical Services Team Checkup Tool	Form and Instruction
Form 6 Attachment E: ICU/Non-ICU Team Checkup Tool	Form and Instruction
Form 6 Team Checkup Tool	Form and Instruction
Form 5 Attachment D: LTC Gap Analysis	Form and Instruction
Form 4 Attachment C: Surgical Services Gap Analysis	Form and Instruction
Form 3 Attachment B: ICU/Non-ICU Gap Analysis	Form and Instruction
Form 3 Gap Analysis	Form and Instruction
Form 2 2,500	Form and Instruction
Form 2 Attachment I: Survey of Patient Safety Culture – NHSOPS	Form and Instruction
Form 1 Attachment H: Survey of Patient Safety Culture – HSOPS	Form and Instruction
Form 1 Attachment H: Survey of Patient Safety Culture – HSOPS	Form and Instruction
SSA revised highlighted changes_22.05.17 - updates to HSOPS 22.06.16_mc.docx	Supporting Statement A
SSB revised highlighted changes_22.05.17 - updates to HSOPS 6.15.22_mc.docx	Supporting Statement B
Att P Schedule of Evaluation Activities.docx	Supplementary Document
Att O Completion Guide for LTC Clinical Outcomes Data.docx	Supplementary Document
Att N Completion Guide for Surgical Services Clinical Outcomes Data.docx	Supplementary Document
Att M Completion Guide for ICU-Non-ICU Clinical Outcomes Data.docx	Supplementary Document
Attachment J - Subsequent data pull for 10% of units	Form and Instruction
Attachment J - Subsequent data pull for 10% of units	Form and Instruction
Attachment Q: Survey of Patient Safety Culture-HSOPS V.2	Form and Instruction
Attachment Q: Survey of Patient Safety Culture-HSOPS V.2	Form and Instruction
Attachment L: Clinical Outcomes Data for LTC	Form and Instruction
Attachment L: Clinical Outcomes Data for LTC	Form and Instruction
Attachment K: Clinical Outcomes Data for Surgical Services	Form and Instruction
Attachment K: Clinical Outcomes Data for Surgical Services	Form and Instruction
Attachment J: Clinical Outcomes Data for ICU/Non-ICU	Form and Instruction
Attachment J: Clinical Outcomes Data for ICU/Non-ICU	Form and Instruction
Attachment L: Clinical Outcomes Data for LTC	Form and Instruction
Attachment L: Clinical Outcomes Data for LTC	Form and Instruction
Attachment K: Clinical Outcomes Data for Surgical Services	Form and Instruction
Attachment K: Clinical Outcomes Data for Surgical Services	Form and Instruction
Attachment J: Clinical Outcomes Data for ICU/Non-ICU	Form and Instruction
Attachment J: Clinical Outcomes Data for ICU/Non-ICU	Form and Instruction
Attachment J: Clinical Outcomes Data for ICU/Non-ICU	Form and Instruction
Attachment J: Clinical Outcomes Data for ICU/Non-ICU	Form and Instruction
Attachment J: Clinical Outcomes Data for ICU/Non-ICU	Form and Instruction
Attachment J: Clinical Outcomes Data for ICU/Non-ICU	Form and Instruction
TEAM CHECK-UP TOOL – Long-Term Care (LTC)	Form and Instruction
TEAM CHECK-UP TOOL – Long-Term Care (LTC)	Form and Instruction
Team Checkup Tool	Form and Instruction
Team Checkup Tool	Form and Instruction
Team Checkup Tool	Form and Instruction
Gap Analysis	Form and Instruction
Gap Analysis	Form and Instruction
Gap Analysis	Form and Instruction
Gap Analysis	Form and Instruction
Attachment I: Survey of Patient Safety Culture – NHSOPS	Form and Instruction
Attachment I: Survey of Patient Safety Culture – NHSOPS	Form and Instruction
Attachment H: Survey of Patient Safety Culture – HSOPS	Form and Instruction
Attachment H: Survey of Patient Safety Culture – HSOPS	Form and Instruction

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Concluded	Action
202209-0935-004	Revision of a currently approved collection	2022-10-19		Approved without change
202107-0935-003	New collection (Request for a new OMB Control Number)	2021-07-26		Approved with change