Hospital Information Form

Collection of Information for AHRQ's Hospital Survey on Patient Safety Culture Comparative Database

OMB: 0935-0162

IC ID: 191670

Documents and Forms
Information Collection (IC) Details

View Information Collection (IC)

Hospital Information Form
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Form #4 Hospital Information Form Attachment A-10 -- Hospital Information Form.doc Yes Yes Fillable Fileable

Health Consumer Health and Safety

 

250 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 750 0 750 0 0 0
Annual IC Time Burden (Hours) 63 0 63 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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