Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
3. AHRQ Patient Safety Culture Surveys:c. NHSOPS (Cohort 3) New 8334 4167 0 Form and Instruction 3c Attachment G: The Nursing Home Survey on Patient Safety Culture (NHSOPS)
3. AHRQ Patient Safety Culture Surveys:d. MOSOPS (Cohort 4) New 4167 2084 0 Form and Instruction 3d Attachment H: The Medical Office Survey on Patient Safety Culture (MOSOPS)
AHRQ Patient Safety Culture Surveys:HSOPS, NHSOPS, MOSOPS (Cohort 1) New 166 83 0 Form and Instruction 3a Attachment F: The Hospital Survey on Patient Safety Culture (HSOPS)
Form and Instruction 3a2 Attachment G: The Nursing Home Survey on Patient Safety Culture (NHSOPS)
Form and Instruction 3a3 Attachment H: The Medical Office Survey on Patient Safety Culture (MOSOPS)
EHR data (Cohorts 1, 2, and 3) New 4008 4008 0 Instruction
Semi-structured qualitative interviews (Cohort 1): Other Health Practitioners New 120 120 0 Form and Instruction 4 - b Attachment J: Draft Interview Guide for Semi-Structured Interviews – Frontline workers
Semi-structured qualitative interviews (Cohort 1): Physicians New 60 60 0 Form and Instruction 4 - I Attachment I: Draft Interview Guide for Semi-Structured Interviews – Antibiotic
Structural Assessments – Cohort 4 (baseline) New 167 33 0 Form and Instruction b1. Structural Assessments – Cohort 4 (baseline) Attachment B Structural Assessment for Ambulatory Care Setting
Structural Assessments – Cohorts 1, 2 and 3 (baseline, post-intervention) New 686 137 0 Form and Instruction a1 Structural Assessments – Cohorts 1, 2 and 3 Attachment A: Structural Assessment for Acute Care Setting
Form and Instruction a2 Structural Assessments – Cohorts 1, 2 and 3 a2 Structural Assessments – Cohorts 1, 2 and 3
Form and Instruction a3 Structural Assessments – Cohorts 1, 2 and 3 Attachment C: Structural Assessment for Long Term Care Setting
Team Antibiotic Review Form (Cohorts 1, 2, and 3) New 30330 7583 0 Form and Instruction D Attachment D: Team Antibiotic Review Form
Form and Instruction E Attachment E: Completion Guide for Team Antibiotic Review Form
The AHRQ Safety Program for Improving Antibiotic Use b. HSOPS (Cohort 2) New 8334 4167 0 Form and Instruction 3b Attachment F: The Hospital Survey on Patient Safety Culture (HSOPS)
Total burden requested under this ICR: 56372 22442 0  
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