Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Feasibility Study for a MEPS Monthly Check-In Unchanged 195 90 0 Form and Instruction 1B
Form and Instruction 1C
Form and Instruction 1F
Form and Instruction 1G
Form and Instruction 1H
Form and Instruction 1I
Form and Instruction 2B
Form and Instruction 2E
Instruction
Instruction
Field Test of A Survey of End-of-Life Care Unchanged 510 97 0 Form and Instruction 1
MEPS Alternative Sampling Design Pilot Test Unchanged 3393 567 0 Form and Instruction 1
Patient and Caregiver Survey Unchanged 90 90 0 Form and Instruction 1
Patient and Caregiver Usability Interview Unchanged 10 10 0 Form and Instruction 1
Pilot Test of Proposed Revisions to the Nursing Home Survey on Patient Safety Culture (NH SOPS) to Version 2.0, with the Workplace Safety Supplemental Item Set for Nursing Homes New 3012 1248 0 Form and Instruction 1
Pilot Test of the Proposed Workplace Safety Supplemental Item Set For the AHRQ Surveys on Patient Safety Culture™ (SOPS®) Nursing Home Survey Unchanged 4309 1432 0 Form and Instruction 1
Form and Instruction 2
Form and Instruction 3
Form and Instruction Attachment F
Pilot Test of the Revised Data Collection Method for the Medical Expenditure Panel Survey - Insurance Component Unchanged 3000 1180 0 Form and Instruction 1
Form and Instruction 2
Pretest of the Proposed Revisions to the Medical Office Survey on Patient Safety Culture (MO SOPS) to Version 2.0, with New Workplace Safety Supplemental Items for Medical Offices New 1065 463 0 Form and Instruction 3
Form and Instruction 5
Form and Instruction 6
Form and Instruction 4
Form and Instruction 1, 2
Provider Focus Group Unchanged 20 30 0 Form and Instruction 1
Provider and Patient Interview Unchanged 13 13 0 Form and Instruction 1
Total Burden Actually Used for Information Collections Under Currently Approved ICR: 15617 5220 0  
Total Burden Currently Requested for Information Collections Under Currently Approved ICR: 0 0 0  
To view an IC, click on IC Title