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 Attachment K: Antibiotic Prescription Data Template_Antibiotic Stewardship Cohort
Clinical Data Collection Instrument_Cancer Diagnostic Process Cohort New 4860 1620 0 Form and Instruction 10 Attachment J: Clinical Data Collection Instrument_Cancer Diagnostic Process Cohort
Diagnostic Safety Supplement New 700 140 0 Form and Instruction 5 Attachment E: Diagnostic Safety Supplement
Interview Guide for Semi-Structured Interviews New 24 24 0 Form and Instruction 8 Attachment H: Draft Interview Guide for Semi-Structured Interviews_ Cancer Diagnostic Process Cohort
Form and Instruction 9 Attachment I: Draft Interview Guide for Semi-Structured Interviews_Antibiotic Stewardship Cohort
Participant Experience Survey_Antibiotic Stewardship Cohort New 125 42 0 Form and Instruction 7 Attachment G: Participant Experience Survey_Antibiotic Stewardship Cohort
Participant Experience Survey_Cancer Diagnostic Process Cohort New 75 13 0 Form and Instruction 6 Attachment F: Participant Experience Survey_Cancer Diagnostic Process Cohort
Structural Assessments New 400 80 0 Form and Instruction 1 Attachment A: Structural Assessment_Cancer Diagnostic Process Cohort
Form and Instruction 2 Attachment B: Structural Assessment_Antibiotic Stewardship Cohort
The Medical Office Survey on Patient Safety Culture (MOSOPS) New 1866 933 0 Form and Instruction 4 Attachment D: The Medical Office Survey on Patient Safety Culture (MOSOPS)
The Office Readiness Survey_Cancer Diagnostic Process Cohort New 350 29 0 Form and Instruction 3 Attachment C: The Office Readiness Survey_Cancer Diagnostic Process Cohort
Total burden requested under this ICR: 11100 5581 0  
To view an IC, click on IC Title