Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Disclosure Form Removed 0 0 0 Form and Instruction Form #3
Disclosure Form - Revised New 17 9 0 Form and Instruction Form #3
Information Form Removed 0 0 0 Form and Instruction Form #5
Information Form - Revised New 33 17 0 Form and Instruction Form #5
Patient Safety Confidentiality Complaint Form Removed 0 0 0 Form and Instruction Form #6
Patient Safety Confidentiality Complaint Form - Revised New 50 17 0 Form and Instruction Form #6
Patient Safety Organization Certification Form Removed 0 0 0 Form and Instruction Form #1
Patient Safety Organization Certification Form - Revised New 33 17 0 Form and Instruction Form #1
Recertification Form Removed 0 0 0 Form and Instruction Form #2
Recertification Form - Revised New 17 9 0 Form and Instruction Form #2
Two-Contract Requirement Form Removed 0 0 0 Form and Instruction Form #4
Two-Contract Requirement Form - Revised New 33 8 0 Form and Instruction Form #4
Total burden requested under this ICR: 183 77 0  
To view an IC, click on IC Title