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) Modified 8334 4167 0 Form and Instruction 3c
3. AHRQ Patient Safety Culture Surveys:d. MOSOPS (Cohort 4) Modified 8334 4167 0 Form and Instruction 3d
AHRQ Patient Safety Culture Surveys:HSOPS, NHSOPS, MOSOPS (Cohort 1) Modified 166 83 0 Form and Instruction 3a
Form and Instruction 3a2
Form and Instruction 3a3
EHR data (Cohorts 1, 2, and 3) Modified 4008 4008 0 Instruction
Monthly template for ambulatory care EHR data extracts (updated New 2505 2505 0 Form and Instruction Attachment M
Semi-structured qualitative interviews (Cohort 1): Other Health Practitioners Modified 120 120 0 Form and Instruction 4 - b
Semi-structured qualitative interviews (Cohort 1): Physicians Modified 60 60 0 Form and Instruction 4 - I
Structural Assessments – Cohort 4 (baseline) Modified 334 67 0 Form and Instruction b1. Structural Assessments – Cohort 4 (baseline)
Structural Assessments – Cohorts 1, 2 and 3 (baseline, post-intervention) Modified 686 137 0 Form and Instruction a1 Structural Assessments – Cohorts 1, 2 and 3
Form and Instruction a2 Structural Assessments – Cohorts 1, 2 and 3
Form and Instruction a3 Structural Assessments – Cohorts 1, 2 and 3
Team Antibiotic Review Form (Cohorts 1, 2, and 3) Modified 30330 7583 0 Form and Instruction D
Form and Instruction E
The AHRQ Safety Program for Improving Antibiotic Use b. HSOPS (Cohort 2) Modified 8334 4167 0 Form and Instruction 3b
Total burden requested under this ICR: 63211 27064 0  
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