Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Disclosure Form New 16 8 0 Form and Instruction Form #3 Disclosure Form
Information Form New 33 17 0 Form and Instruction Form #5 Information Form
Patient Safety Confidentiality Complaint Form New 50 17 0 Form and Instruction Form #6 Patient Safety Confidentiality Complaint Form
Patient Safety Organization Certification Form New 33 17 0 Form and Instruction Form #1 Patient Safety Organization Certification Form
Recertification Form New 16 8 0 Form and Instruction Form #2 Recertification Form
Two-Contract Requirement Form New 33 8 0 Form and Instruction Form #4 Two-Contract Requirement Form
Total burden requested under this ICR: 181 75 0  
To view an IC, click on IC Title