Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Antibiotic Prescription Data Template_Antibiotic Stewardship Cohort New 2700 2700 0 Form and Instruction 11
Clinical Data Collection Instrument_Cancer Diagnostic Process Cohort New 4860 1620 0 Form and Instruction 10
Diagnostic Safety Supplement New 700 140 0 Form and Instruction 5
Interview Guide for Semi-Structured Interviews New 24 24 0 Form and Instruction 8
Form and Instruction 9
Participant Experience Survey_Antibiotic Stewardship Cohort New 125 42 0 Form and Instruction 7
Participant Experience Survey_Cancer Diagnostic Process Cohort New 75 13 0 Form and Instruction 6
Structural Assessments New 400 80 0 Form and Instruction 1
Form and Instruction 2
The Medical Office Survey on Patient Safety Culture (MOSOPS) New 1866 933 0 Form and Instruction 4
The Office Readiness Survey_Cancer Diagnostic Process Cohort New 350 29 0 Form and Instruction 3
Total burden requested under this ICR: 11100 5581 0  
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