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

View Information Collection (IC)

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
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 3 Medical Office Point of Contact (POC) Instructions Attachment D - Medical Office Point of Contact (POC) Instructions.docx Yes Yes Fillable Fileable
Form and Instruction 5 Medical Office Background Information Form Attachment E - Medical Office Background Information Form.docx Yes Yes Fillable Fileable
Form and Instruction 6 Pretest of SOPS Medical Office Survey 2.0 and Workplace Safety Supplemental Items - REVISED Attachment A - Pretest of MO SOPS 2.0 and WPS Supplemental - revised.docx Yes Yes Fillable Fileable
Form and Instruction 4 Attachment B - Medical Office Data Use Agreement (DUA) - REVISED Attachment B - Medical Office Data Use Agreement (DUA) - Revised.docx Yes Yes Fillable Fileable
Form and Instruction 1, 2 MO Survey Version 2.0 and Workplace Safety Supplemental Items Cognitive Interview Guide - REVISED Attachment C - MO SOPS Version 2.0 and WPS Supplemental Items Cognitive - Revised.docx No   Printable Only

Health Health Care Services

 

1,065 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  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 1,065 0 1,065 0 0 0
Annual IC Time Burden (Hours) 463 0 463 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment F - Survey Invitation and Reminder Notices Attachment F - Survey Invitation and Reminder Notices.docx 07/10/2025
Attachment G - Technical Expert Panel Members Attachment G - Technical Expert Panel Members.docx 07/10/2025
Supporting Statement Part B Supporting Statement Part B - MO SOPS 2.0 and WPS_2-3-25_clean.docx 07/10/2025
Supporting Statement A Supporting Statement Part A - MO SOPS 2.0 and WPS - revised.docx 08/01/2025
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.