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ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Pilot Test of the Proposed Workforce Safety Supplemental Item Set For the Surveys on Patient Safety Culture
Agency IC Tracking Number:
IC Status:
New
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
1
Draft Workforce Safety Cognitive Interview Guide
Attachment B - Draft Workforce Safety Cognitive Interview Guide_8-3-20.docx
Yes
Yes
Fillable Fileable
Form and Instruction
2
Attachment C: Hospital Point of Contact (POC) Instructions
Attachment C - Hospital Point of Contact (POC) Instructions_8-3-20.docx
Yes
Yes
Fillable Fileable
Form and Instruction
3
Attachment A: Draft Workforce Safety Supplemental Item
Attachment A - Draft Workforce Safety Supplemental Item Set_8-3-20.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
5,782
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits, Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
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
5,782
0
5,782
0
0
0
Annual IC Time Burden (Hours)
1,935
0
1,935
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Cover Memo
OMB Cover Letter.docx
08/19/2020
Supporting Statement Part A
Supporting Statement Part A - Pilot Test of SOPS Workforce Safety_7-28-20 EC.docx
08/19/2020
Supporting Statement Part B
Supporting Statement Part B - Pilot Test of SOPS Workforce Safety 7-28-20.docx
08/19/2020
Attachment D: Survey Invitation and Reminder Notices
Attachment D - Survey Invitation and Reminder Notices.docx
08/19/2020
Attachment E: Subject Matter Experts and Technical Expert Panel Members
Attachment E - Subject Matter Experts.docx
08/19/2020
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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The .gov means it's official.
The site is secure.
