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View Information Collection (IC)
View Information Collection (IC)
IC Title:
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
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
SOPS Nursing Home Survey with Workplace Safety Supplemental Item Set
Attachment A - SOPS Nursing Home Survey with Workplace Safety Supplemental Item Set.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Consumer Health and Safety
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
3,012
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:
37 %
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
3,012
0
3,012
0
0
0
Annual IC Time Burden (Hours)
1,248
0
1,248
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Attachment B - Nursing Home Data Use Agreement (DUA)
Attachment B - Nursing Home Data Use Agreement (DUA).docx
05/09/2024
Attachment C - Nursing Home Background Information Form
Attachment C - Nursing Home Background Information Form.docx
05/09/2024
Attachment D - Nursing Home Point of Contact (POC) Instructions
Attachment D - Nursing Home Point of Contact (POC) Instructions.docx
05/09/2024
Attachment E - Survey Invitation and Reminder Notices
Attachment E - Survey Invitation and Reminder Notices.docx
05/09/2024
Attachment F - Technical Expert Panel members
Attachment F - Technical Expert Panel members.docx
05/09/2024
Supporting Statement Part A - Pilot Test of NH SOPS 2.0
Supporting Statement Part A - Pilot Test of NH SOPS 2.0.docx
05/10/2024
Supporting Statement Part B - Pilot Test of NH SOPS 2.0
Supporting Statement Part B - Pilot Test of NH SOPS 2.0.docx
05/10/2024
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.
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