Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Attachment H: Survey of Patient Safety Culture – HSOPS New 18334 4584 0 Form and Instruction 1
Attachment I: Survey of Patient Safety Culture – NHSOPS New 5000 1250 0 Form and Instruction 2
Attachment J: Clinical Outcomes Data for ICU/Non-ICU New 27 135 0 Form and Instruction 9
Attachment J: Clinical Outcomes Data for ICU/Non-ICU New 1602 801 0 Form and Instruction 9
Attachment J: Clinical Outcomes Data for ICU/Non-ICU New 27 14 0 Form and Instruction 9
Attachment J: Clinical Outcomes Data for ICU/Non-ICU New 267 935 0 Form and Instruction 9
Attachment K: Clinical Outcomes Data for Surgical Services New 120 60 0 Form and Instruction 10
Attachment K: Clinical Outcomes Data for Surgical Services New 20 10 0 Form and Instruction 10
Attachment L: Clinical Outcomes Data for LTC New 100 500 0 Form and Instruction 11
Attachment L: Clinical Outcomes Data for LTC New 1800 900 0 Form and Instruction 11
Gap Analysis New 934 934 0 Form and Instruction 3
Form and Instruction 4
Form and Instruction 5
TEAM CHECK-UP TOOL – Long-Term Care (LTC) New 1800 306 0 Form and Instruction 8
Team Checkup Tool New 6606 1123 0 Form and Instruction 6
Form and Instruction 7
Total burden requested under this ICR: 36637 11552 0  
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