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 H: Survey of Patient Safety Culture – HSOPS
Attachment I: Survey of Patient Safety Culture – NHSOPS New 5000 1250 0 Form and Instruction 2 2,500
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
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
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
Attachment J: Clinical Outcomes Data for ICU/Non-ICU New 267 935 0 Form and Instruction 9 Attachment J: Clinical Outcomes Data for ICU/Non-ICU
Attachment K: Clinical Outcomes Data for Surgical Services New 120 60 0 Form and Instruction 10 Attachment K: Clinical Outcomes Data for Surgical Services
Attachment K: Clinical Outcomes Data for Surgical Services New 20 10 0 Form and Instruction 10 Attachment K: Clinical Outcomes Data for Surgical Services
Attachment L: Clinical Outcomes Data for LTC New 100 500 0 Form and Instruction 11 Attachment L: Clinical Outcomes Data for LTC
Attachment L: Clinical Outcomes Data for LTC New 1800 900 0 Form and Instruction 11 Attachment L: Clinical Outcomes Data for LTC
Gap Analysis New 934 934 0 Form and Instruction 3 Attachment B: ICU/Non-ICU Gap Analysis
Form and Instruction 4 Attachment C: Surgical Services Gap Analysis
Form and Instruction 5 Attachment D: LTC Gap Analysis
TEAM CHECK-UP TOOL – Long-Term Care (LTC) New 1800 306 0 Form and Instruction 8 Attachment G: LTC Team Checkup Tool
Team Checkup Tool New 6606 1123 0 Form and Instruction 6 Attachment E: ICU/Non-ICU Team Checkup Tool
Form and Instruction 7 Attachment F: Surgical Services Team Checkup Tool
Total burden requested under this ICR: 36637 11552 0  
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