View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

Pilot Test of the Proposed Diagnostic Safety Supplemental Item Set for the Medical Office Survey on Patient Safety Culture
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 Yes Yes Fillable Fileable
Form and Instruction 2 Yes Yes Fillable Fileable
Form and Instruction 3 Yes Yes Fillable Fileable
Form and Instruction 4 Yes Yes Fillable Fileable
Form and Instruction 5 Yes Yes Fillable Fileable

Health Health Care Services

 

1,545 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,545 0 1,545 0 0 0
Annual IC Time Burden (Hours) 538 0 538 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Cover Letter 05/03/2019
Attachment C1: Medical Office Point of Contact (POC) Instructions 05/03/2019
Attachment D: Survey Invitation and Reminder Notices 05/03/2019
Attachment E: Federal Register Notice 05/03/2019
Attachment F: Technical Expert Panel Members 05/03/2019
Supporting Statement A 05/03/2019
Supporting Statement Part B 05/03/2019
Supporting Statement A 08/07/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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