Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Attachment C_Patient Safety Organization Certification for Initial Listing Form Unchanged 11 198 0 Form and Instruction Form 1
Attachment D_PSO Certification for Continued Listing Form Unchanged 40 320 0 Form and Instruction Form 2
Attachment E_PSO Two Bona Fide Contracts Requirement Form Unchanged 56 56 0 Form and Instruction Form 3
Attachment F_PSO Disclosure Statement Form Unchanged 3 9 0 Form and Instruction Form 4
Attachment G_PSO Profile Form Modified 74 222 0 Form and Instruction Form 5
Attachment H_PSO Change of Listing Information Unchanged 51 4 0 Form and Instruction Form 6
Attachment I_OCR Complaint Consent Form Unchanged 1 0 0 Form and Instruction 8
Attachment J_PSO Voluntary Relinquishment Form Unchanged 4 2 0 Form and Instruction Form 7
Attachment K_AHRQ Common Formats Unchanged 1000 100000 0 Form and Instruction Form 9
Total burden requested under this ICR: 1240 100811 0  
To view an IC, click on IC Title