Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Attachment B – Safety culture survey_Data collection instrument Modified 1000 250 0 Form and Instruction 1
Attachment D – Patient Experience Survey_Data collection instrument Modified 980 363 0 Form and Instruction 2
Attachment J – Data collection instrument: Site Visit Assessment Modified 18 72 0 Form and Instruction 5
Readiness and Implementation assessment Modified 684 684 0 Form and Instruction 3
Form and Instruction 4
Total burden requested under this ICR: 2682 1369 0  
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